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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 72 out of 5,069

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VAERS ID: 1440245 (history)  
Form: Version 2.0  
Age: 20.0  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Nausea, Syncope, Tremor, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Nausea-Mild, Systemic: Shakiness-Mild, Additional Details: Spoke with nurse at md office and instructed to give sports drink (sugar) for shakiness


VAERS ID: 1440248 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Missouri  
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 EW0186 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Flushing, Hyperhidrosis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (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: Flushed / Sweating-Mild, Additional Details: After administration of first vaccine patient was having lightheadedness/dizziness. Patient was also flushed and experiencing sweating. Had patient lay on floor with feet elevated and symptoms improved within 5 minutes.


VAERS ID: 1440252 (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: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Headache, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Slight Fever, Moderate Headache. Muscle soreness.


VAERS ID: 1440387 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Illinois  
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 FA6780 / 3 LA / IM

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

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

Write-up: RESIDENT HAD RECEIVED A DOSE IN JANUARY 2021 AND JUNE 8TH 2021


VAERS ID: 1440392 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
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 (MODERNA)) / MODERNA - / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Folic Acid Tablet 1 MG Cyanocobalamin Tablet 1000 MCG Docusate Sodium Capsule 100 MG Famotidine Tablet 20 MG Atorvastatin Calcium Tablet 80 MG
Current Illness: hx of CVA
Preexisting Conditions: HEMIPLEGIA AND HEMIPARESIS FOLLOWING CEREBRAL INFARCTION AFFECTING LEFT NON-DOMINANT SIDE CHRONIC ATRIAL FIBRILLATION DYSPHAGIA FOLLOWING CEREBRAL INFARCTION
Allergies: NKA
Diagnostic Lab Data: Monitor pt for adverse reactions
CDC Split Type:

Write-up: Vaccine was given on day 21 No adverse reaction at this time.


VAERS ID: 1440395 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Indiana  
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 - / 2 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Fatigue, Hot flush, Migraine, Pain, Restlessness
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (broad)

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

Write-up: Restlessness Migraine Body aches Hot flashes Chills Fatigue


VAERS ID: 1440396 (history)  
Form: Version 2.0  
Age: 85.0  
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 (MODERNA)) / MODERNA - / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine Sodium Tablet 100 MCG Furosemide Tablet 20 MG cloNIDine HCl Tablet 0.1 MG Metoprolol Tartrate Tablet 25 MG Apixaban Tablet 2.5 MG GlipiZIDE Tablet 10 MG Potassium Chloride ER Tablet Extended Release 10 MEQ Aspirin EC Tablet De
Current Illness: NA
Preexisting Conditions: HTN DM A-Fib CAD Hypothyroid HLD Dementia
Allergies: Penicillin
Diagnostic Lab Data: cont. to monitor pt for adverse reactions
CDC Split Type:

Write-up: Vaccine was given on day 21 No adverse reactions at this time


VAERS ID: 1440400 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
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 (MODERNA)) / MODERNA - / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Famotidine Tablet 20 MG Flomax Capsule 0.4 MG (Tamsulosin HCl) Atorvastatin Calcium Tablet 40 MG Semglee Solution Pen-injector 100 UNIT/ML (Insulin Glargine) Clopidogrel Bisulfate Tablet 75 MG Phenazopyridine HCl Tablet 100 MG Ascorbic Acid
Current Illness: Recent R AKA
Preexisting Conditions: CHF A-fib DM PVD
Allergies: NKA
Diagnostic Lab Data: cont. monitoring for adverse reaction
CDC Split Type:

Write-up: Vaccine was given on day 21 no adverse reactions noted at this time.


VAERS ID: 1440401 (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: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Stalevo 125 Tablet 31.25-125-200 MG (Carbidopa-Levodopa-Entacapone) Xiidra Solution 5 % (Lifitegrast) Refresh Tears Solution (Carboxymethylcellulose Sodium) Trihexyphenidyl HCl Tablet 2 MG MetFORMIN HCl Tablet 500 MG Vitamin C Tablet (Ascor
Current Illness: NA
Preexisting Conditions: Parkinsons DM HTN Hypothyroidism
Allergies: Sulfa Antibiotics
Diagnostic Lab Data: cont. to monitor for adverse reactions
CDC Split Type:

Write-up: Vaccine was given on day 21 no adverse reaction at this time


VAERS ID: 1440421 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Michigan  
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 EW0191 / 2 RA / -

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

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

Write-up: Patient came to office for 2nd dose of Pfizer COVID vaccine. She was only 12 days from her first dose. Physician counseled patient and let her know she was too early to receive the second dose. Patient was extremely insistent that she receive her second dose and declined to schedule another appointment. Patient decided to go ahead and receive dose two even though she was early.


VAERS ID: 1440438 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
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 (MODERNA)) / MODERNA - / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Memantine HCl Tablet 10 MG Tamsulosin HCl Capsule 0.4 MG Folic Acid Tablet 1 MG Senna Tablet 8.6 MG (Sennosides) Apixaban Tablet 2.5 MG Atorvastatin Calcium Tablet 20 MG Levothyroxine Sodium Tablet 25 MCG Metoprolol Tartrate Tablet 25 MG Fe
Current Illness: NA
Preexisting Conditions: A-fib HTN CKD BPH HLD Alzheimers
Allergies: NKA
Diagnostic Lab Data: cont. to monitor for any adverse reactions
CDC Split Type:

Write-up: Vaccine was given on day 21 no adverse reactions noted at this time


VAERS ID: 1440445 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
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 (MODERNA)) / MODERNA - / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Gabapentin Tablet 200 mg Famotidine Tablet 20 MG Atorvastatin Calcium Tablet 10 MG Aspirin EC Tablet Delayed Release 81 MG (Aspirin) Senna-Plus Tablet 8.6-50 MG (Sennosides-Docusate Sodium) amLODIPine Besylate Tablet 2.5 MG GlycoLax Powder
Current Illness: NA
Preexisting Conditions: HTN HLD
Allergies: NKA
Diagnostic Lab Data: cont. to monitor for adverse reactions
CDC Split Type:

Write-up: Vaccine given on day 21, no adverse reactions noted at this time


VAERS ID: 1440453 (history)  
Form: Version 2.0  
Age: 89.0  
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 (MODERNA)) / MODERNA - / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Acetaminophen Tablet 325 MG LORazepam Tablet 0.5 MG
Current Illness: NA
Preexisting Conditions: HTN GERD Hospice Care CKD HLD DM Anemia Dementia
Allergies: NKA
Diagnostic Lab Data: cont. to monitor for adverse reactions
CDC Split Type:

Write-up: Vaccine given on day 21 with no adverse reactions noted at this time


VAERS ID: 1440484 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Nevada  
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 EW0198 / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness:
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: incorrect mixing covid shot Pfizer brand administered as second dose, patient originally received moderna brand as first dose


VAERS ID: 1440487 (history)  
Form: Version 2.0  
Age: 38.0  
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 (MODERNA)) / MODERNA - / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: NKA
Diagnostic Lab Data: cont. to monitor for any adverse reactions
CDC Split Type:

Write-up: Vaccine given on day 21 with no adverse reaction at this time


VAERS ID: 1440515 (history)  
Form: Version 2.0  
Age: 78.0  
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 (MODERNA)) / MODERNA - / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril Tablet 20 MG MetFORMIN HCl Tablet 500 MG Omeprazole Tablet Delayed Release 20 MG Mirtazapine Tablet 15 MG
Current Illness: NA
Preexisting Conditions: CKD Dementia HTN HLD VIt D deficiency depression anemia
Allergies: Levaquin, Macrobid
Diagnostic Lab Data: cont. to monitor for adverse reactions
CDC Split Type:

Write-up: Vaccine given on day 21, with no adverse reactions noted at this time


VAERS ID: 1440523 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Georgia  
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 EW0171 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Feeling hot, Heart rate increased, Hypoaesthesia, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: obesity, asthma, hashimoto''s, thyroiditis
Allergies: zantac
Diagnostic Lab Data: paramedics called and they assessed her and everything was good, everything went back to normal except pulse was a little high
CDC Split Type:

Write-up: patient said her legs were numb, her face was warm and tingly, and appeared she had trouble breathing


VAERS ID: 1440529 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Maryland  
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 051C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: no known
Preexisting Conditions:
Allergies: no known
Diagnostic Lab Data: n/a; patient does not report any symtpoms or adverse effects
CDC Split Type:

Write-up: Patient had previously received Janssen Covid-19 vaccine on 04/06/2021. No current recommendation for booster doses or taking vaccine by additional different manufacturer


VAERS ID: 1440547 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Wisconsin  
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 EW0183 / 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? 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: Client attended a vaccine clinic and requested Pfizer vaccine. Client completed the vaccine consent form indicating he had not had a previous Covid 19 vaccine and signed the form prior to administration. RN administered Pfizer #1 to client. Upon entry of completed vaccine into the Immunization Registry, RN noted that client had previously had a Johnson & Johnson Covid 19 vaccine on 04/01/2021. RN emailed Department of Health Services Covid 19 Vaccine Team for consultation as to next steps. Email was received back advising that client was complete for Covid vaccine series and that a VAERS Report should be submitted. Client was called 07/01/2021 at 1018 and notified he had previously received a Johnson & Johnson vaccine, was complete for Covid 19 vaccine series and was not in need of receiving the second dose of Pfizer. Client admitted he was aware he had received a Johnson & Johnson Covid 19 vaccine in the past. Client verbalized he was confused as to needing the Pfizer vaccine and that it was "better to be protected". Client was reassured that he was fully vaccinated with the previous Johnson & Johnson vaccine.


VAERS ID: 1440571 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: New Hampshire  
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 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

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

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

Write-up: The patient was waiting the regular 15 min after vaccination and with 10-12 minutes I heard a big sound . I ran and out site the Pharmacy Department and the patient was just getting up from the floor after a fainting episode. The patient was sweating perfusely and he was very pale and very warm to the touch.


VAERS ID: 1440575 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Washington  
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 / SYR

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: not known
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: no symptoms patient under age recommendation


VAERS ID: 1440580 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Maryland  
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 036C21A / 2 LA / IM

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

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

Write-up: One of the pre-drawn syringes malfunctioned at administration of the vaccine. Unknown amount leaked out of the syringe at injection. It was explained to the patient since he may have not received the complete dose it would be recommended to repeat the vaccine at which time the patient refused.


VAERS ID: 1440584 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Oregon  
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 (MODERNA)) / MODERNA - / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Suppressed lactation
SMQs:, Functional lactation disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertraline 50mg Echinacea Garlic pills Acidophilus Prenatal
Current Illness:
Preexisting Conditions:
Allergies: Clyndamyacin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Significant decrease in breastmilk production. More than 50%


VAERS ID: 1440594 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-02-06
Onset:2021-06-30
   Days after vaccination:144
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Chills, Computerised tomogram thorax normal, Dyspnoea, Full blood count normal, Headache, Malaise, Metabolic function test normal, Pain, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: asthma, COPD, CAD, HLD, HTN, migraines
Allergies: Thallous Chloride Tl 201 technetium containing compounds
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is a 59 y/o F with asthma, COPD, CAD, HLD, HTN, migraines who presents form for COVID pneumonia. Per ED note, patient had been feeling well until this morning when she woke up with headache, body aches, chills, and mild SOB. States she felt similar to when she received her COVID vaccines back in April. Denies runny nose, congestion, cough, wheezing, chest pain, N/V/D, abdominal pain, pain/blood with urination. On arrival vitals notable for T 39.5, HR 124, 142/98, O2 88% requiring 2L. Found to be COVID (+). CMP and CBC WNL. CT PE neg. Of note, patient has history of COPD but has never required home O2. Feeling much better after tylenol, but still feels like she has to work a bit harder to breathe.


VAERS ID: 1440625 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-04-13
Onset:2021-06-30
   Days after vaccination:78
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Decreased appetite, Dyspnoea, Nausea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness:
Preexisting Conditions: HLD,DMII and Hypothyroidism
Allergies: sulfa and morphine
Diagnostic Lab Data: Tested positive on PCR 6/30/21
CDC Split Type:

Write-up: Pt hospitalized for COVID19 on 6/30/2021. Has had 1 week of SOB. Tested negative on 6/28 at PCP office. His shortness of breath started getting worse since then associated with dry cough, loss of appetite and nausea. Denies fever, chills and abdominal pain. Denies recent sick contact. Tested positive for COVID19 on 6/30/21


VAERS ID: 1440663 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Kansas  
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 EW0179 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Erythema, Pain, Pain in extremity, Skin warm
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: At approximately 3-4 minutes after vaccination patient complained burning pain in her arm. Mom notified RN. RN evaluated. Left arm red from shoulder to wrist. Her left arm was hot to the touch. Cold water bottles and then ICE applied to her arm. Mom instructed to call PCP. Mom put a call into PCP. RN noticed patientss chest becoming red. Paramedic requested to evaluate. The RN administered 50 mg PO Benadryl per standing order. By 7:35 pt. arm starting to appear less red and pt. reported less burning sensation. Mom reports pt is doing fine this morning.


VAERS ID: 1440687 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Vermont  
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 EW0181 / 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: none
Current Illness: Lyme Disease
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: given pure 0.3 mL of undiluted dose without diluent


VAERS ID: 1440694 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Pennsylvania  
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 EW0191 / UNK - / -

Administered by: Work       Purchased by: ?
Symptoms: Gait disturbance, Spinal pain
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Arthritis (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: No
Current Illness: No
Preexisting Conditions: No
Allergies: Aspirin
Diagnostic Lab Data: I?m still waiting if the pain goes a way without going to the doctor
CDC Split Type:

Write-up: After 48 hours, I had a strong spine pain. I could barely walk.


VAERS ID: 1440711 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Virginia  
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 / 2 LA / 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Vomiting-Severe


VAERS ID: 1440722 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Mississippi  
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 ER8729 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartin, Naproxen, Emgality pen, Omega-3 fish oil, Tramadol
Current Illness: Unknown
Preexisting Conditions: HTN, Hypercholesterolemia, Chronic migraine w/ out Aura, Normocytic anemia, Enlarged Thyroid
Allergies: Silver, Codeine, Tamiflu
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Vaccination error: Patient was given 0.3ml of Pfizer vaccine undiluted.


VAERS ID: 1440751 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
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 (MODERNA)) / MODERNA 051C21A / 2 LA / IM

Administered by: Pharmacy       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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Labetalol 200mg Twice daily, Zoloft 100mg once daily, Fenofibrate once daily, Aspirin 81mg
Current Illness:
Preexisting Conditions: High Blood Pressure, High Triglycerides, Depression, High Cholesterol, Family Hx blood clots
Allergies: Penicillin - Rash
Diagnostic Lab Data:
CDC Split Type:

Write-up: After the vaccine was given it was discovered the vaccine was expired past the recommended 12 hour period, at most 31 hours after puncture the dose was given. No adverse reaction was reported and the manufacturer was contacted regarding whether the patient needs to be re-dosed to complete the vaccine series


VAERS ID: 1440762 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Mississippi  
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 ER8735 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect product formulation 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: N/A
CDC Split Type:

Write-up: When I was mixing the vaccine, I drew it up incorrectly. I mixed 0.8 of Sodium Chloride instead of the correct amount which is 1.8. A dose of .3 of the vaccine was administered at that point the patient waited the appropriate wait time with no adverse reaction. My manager called the patients guardian at 5:30 p.m., The patients grandmother stated the patient was fine and had no reaction to the vaccine. The grandmother agreed if there was a reaction she would that the patient to the ER.


VAERS ID: 1440790 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Tennessee  
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 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature increased, Diarrhoea, Fatigue, Headache, Migraine, Nausea, Pain in extremity, Sensitive skin, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: At 1 am (10 hours after the vaccine was administered) my temperature spiked to 102 and I was shaking uncontrollably. The fever continued for several hours, breaking around 3 or 4 in the morning. I woke up at 6 am with a severe migraine and was very nauseated. I also had diarrhea throughout the morning. My arm was also extremely sore and sensitive. I took Excedrin for the migraine, and woke up at 10 am feeling somewhat better. I remained shaky and fatigued throughout the rest of the day. The next day I still felt fatigued with a slight headache.


VAERS ID: 1440811 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Ohio  
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 (MODERNA)) / MODERNA 051C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye swelling, Lymphadenopathy
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: Patient called stating lymph nodes were swollen under neck and under arms. Under eye was a little swollen as well.


VAERS ID: 1440850 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Missouri  
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 EW0181 / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: C-reactive protein normal, Chest X-ray normal, Differential white blood cell count normal, Electrocardiogram normal, Full blood count normal, Metabolic function test normal, Tachycardia, Troponin normal
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (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: Allegra
Current Illness:
Preexisting Conditions: asthma
Allergies: Sulfa Drugs, Lupron Depot
Diagnostic Lab Data: EKG, Blood work (c-reactive protein, comprehensive metabolic panel, CBC with auto differential and Troponin) and chest x-Ray. all came back normal.
CDC Split Type:

Write-up: Rapid heart rate-Tachycardia. resting heart rate at 105 bbm at rest prior to going to the hospital. started on 06/29 in the afternoon. Went to hospital morning of 07/01.


VAERS ID: 1440856 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Missouri  
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 041B21A / 1 LA / IM

Administered by: Public       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: Legally blind
Preexisting Conditions: Legally blind
Allergies: NKA
Diagnostic Lab Data: No
CDC Split Type:

Write-up: She had no reaction. The reason for this report is vaccine was given to a 17 year old, 11 months, and 22 days old, instead of 18 years old as recommended. Upon arrival to our clinic, health history, reviewed and noted no signs or symptoms of distress or allergic/anaphylaxis reaction to any medicine or vaccine in the past. After given Moderna vaccine in left deltoid, Lot# 041B21A, expiration date of 10/04/2021, she waited 20 minutes and in that time, again no adverse reaction or allergic/anaphylaxis noted. After giving her her vaccine card and 20 minute waiting period up. I noted that she was not 18 years old. I informed client and guardian that she is shy of 18 years old and even though she had no adverse reaction/ or anaphylaxis, I still had to write up a report and report it to the proper individuals. Client waited an additional 20 minutes totally 40 minutes and again, no adverse reaction, or anaphylaxis noted. Instructed guardian, grandma, to keep an eye on her for the next 24 hours. She verbalized ok and understanding. Today, July 1, 2021 0900, spoke to guardian and client still has had no adverse or anaphylaxis reaction or any problems noted, but will continue to monitor her.


VAERS ID: 1440857 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Michigan  
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 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Head injury, Injection site haemorrhage, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approximately 3 minutes after he received J&J vaccine he passed out while sitting in a chair. He hit his head on the wall next to the chair. Staff immediately supported him and he stayed in the chair. He regained consciousness within a few seconds. A cot was brought to him, he was assisted by staff and laid on the cot, cool cloth applied to his forehead. Within 8 minutes he was feeling better, sitting up on the cot, drinking water. He did report that he has previously passed out at the sight of blood, and there was a small amount of blood at the injection site. We observed him for another 25 minutes and he returned to baseline, stated he was feeling fine. He went home with his step Dad, who had given him a ride to the clinic. I called the patient 2 hours later to check on him. Step Dad reported he was outside and unavailable, but that he has been feeling fine since leaving the clinic.


VAERS ID: 1440909 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Missouri  
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 (JANSSEN)) / JANSSEN 207A21A / 1 RA / IM

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

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

Write-up: 7 hours after the shot body aches began. 14 hours after the shot headache and nausea were added to the body aches. 20 hours after the shot 100.4 Fahrenheit fever began. Crackers stopped the nausea. Tylenol stopped the headache and brought the temperature down to 96.6? arenheit. Body aches continue 23 hours after the shot.


VAERS ID: 1440926 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-24
Onset:2021-06-30
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 1 LA / IM

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

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

Write-up: Pt developed hives and a rash near site of injection--rash has spread to a larger part of arm--patient used ice for swelling and Benadryl for itching


VAERS ID: 1440947 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Indiana  
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 - / UNK - / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Dyspepsia
SMQs:, Gastrointestinal nonspecific dysfunction (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: Zoloft, Lisopril (Blood pressure pill), Anora Ellipta (COPD)
Current Illness: COPD
Preexisting Conditions: COPD
Allergies: Latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Heart burn complaint later into the night and into the current date/time. My mom has not had heartburn problems in the past.


VAERS ID: 1440959 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Ohio  
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 (JANSSEN)) / JANSSEN 1821287 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft 25mg once daily
Current Illness: no
Preexisting Conditions: psoriasis (comes and goes)
Allergies: No
Diagnostic Lab Data: No
CDC Split Type:

Write-up: About 30 hours after vaccination, patient noticed a sunburn type redness all over his body. Rash was apparent face, neck, chest, stomach, arm, legs, and tops of feet. Rash was warm, but not itchy. Rash was not raised. Resembles a sunburn


VAERS ID: 1440976 (history)  
Form: Version 2.0  
Age: 39.0  
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 009D21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: tizanidine, topamax, levothyroxine, metformin
Current Illness: none indicated
Preexisting Conditions: non listed on pharmacy record profile
Allergies: none listed on pharmacy record profile
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Vaccine was administered to patient at 7-8 hours past the recommended 12-hr BUD (after first puncture). Attempted to contact patient for follow-up monitoring but phone number provided had no voicemail option.


VAERS ID: 1441012 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
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 (JANSSEN)) / JANSSEN - / 1 - / IM

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

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

Write-up: The patient started experiencing nausea/vomiting about 24 hours after vaccination. This was accompanied by abdominal pain. The patient was told to go to urgent care if it continues.


VAERS ID: 1441016 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: New Jersey  
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 ER8729 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Product preparation issue
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: None reported
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None at the present time.
CDC Split Type:

Write-up: Nurse reported to Nurse Manager on 7/1/21 she diluted the vaccine with 0.8 ml. diluent with Pfizer vaccine and administered 0.3ml to patient in right deltoid on 6/30/21. Once she recognized her error she immediately notified provider and pharmacist. She was advised by medical director to contact patient for the next couple of days to ensure that no adverse reactions had occurred. She continues to follow patient daily telephonically and patient is doing well and has not reported any adverse reactions or side effects.


VAERS ID: 1441032 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Wisconsin  
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 EW0181 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain, Arthralgia, Chills, Cough, Diarrhoea, Dizziness, Feeling abnormal, Feeling hot, Headache, Hyperhidrosis, Lymphadenopathy, Pain, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: TC to Client and spoke with patient. Patient received COVID 19 vaccine on 6/30/2021, at 1400. Around 11:00 pm, on 6/30/2021 symptoms started, feeling warm, chills, sweats, headache, body aches, joint pain, brain fog, dizziness, lightheaded, slight coughing episodes, swollen lymph nodes. Per patient, had one time episode of vomiting, having abdomen pain and mild diarrhea. Per patient, some symptoms have subsided, no follow up for medial treatment and has not taken any medications. No underlying medical condition, but is a former smoker, as of two weeks now. PHN recommend that Client follow up with PCP and to call 911 for medical emergency. Patient verbalized understanding information provided by PHN.


VAERS ID: 1441036 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Unknown  
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 EW0191 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cold sweat, 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? 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 vaccine 10:22am, At 10:35am PSt voiced complaints of being faint and nausea, no report of dizziness, HA, or stomach pain. Husband observant, came inside. Attendee''s skin pale/diaphoretic/clammy. Attendee''s respirations were not tachypneic or dyspneic, but were calm. Attendee assisted to the cot to lie down, legs elevated, cold pack. 10:50 Sitting up, VSS felt confident of ambulation, warm and dry sky, report of this same occurance with other lab draws or vaccinations.


VAERS ID: 1441039 (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: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8729 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Product preparation issue
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: None reported
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None at the present time.
CDC Split Type:

Write-up: Nurse reported to Nurse Manager on 7/1/21 she diluted the vaccine with 0.8 ml. diluent instead of 1.8 ml with Pfizer vaccine and administered 0.3ml to patient in left deltoid on 6/30/21. Once she recognized her error she notified provider and pharmacist. She was advised by medical director to contact patient for the next couple of days to ensure that no adverse reactions had occurred. She continues to follow patient daily telephonically and patient is doing well and has not reported any adverse reactions or side effects.


VAERS ID: 1441040 (history)  
Form: Version 2.0  
Age: 81.0  
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 009D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Expired product administered
SMQs:, Anticholinergic syndrome (broad), Vestibular 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: glipizide, lisinopril, aspirin, metformin, januvia
Current Illness: none indicated
Preexisting Conditions: none indicated on pharmacy records
Allergies: none indicated on pharmacy records
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Moderna vaccine was administered at 7 hours past the recommended 12-hr BUD after first puncture. Bottle was kept at room temperature for a total of 20 hrs. Pt reported no significant symptoms the following day after administration, only some lightheadedness the night prior.


VAERS ID: 1441041 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Washington  
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 EWO183-H / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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: Unknown
Current Illness: Unknown (Reports that she had COVID in December 2020)
Preexisting Conditions: Unknown
Allergies: Eggs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Adverse Event: PT was here for first dose of Pfizer, received at 1625. At 1644, PT c/o lightheadedness while sitting in post-observation, presented with diaphoresis . EMTs were called at 1645 and arrived at 1645. PT was assisted to floor by EMTs. Liquids were provided, EMTs began assessment (see VS below) PT was encouraged to drink fluids, educated on vasovagal responses, dehydration effects/management. At approximately 1700, EMTs assisted PT to stand, PT c/o lightheadedness and PT was assisted to seated position with elevated legs without incident. S/S resolved shortly after and PT reported being at baseline. Treatment: Liquids (water and apple juice) were provided, Assessment/Vitals by EMTs (VS at 1700: 110/66 sitting, HR 86, SPO2 99% RA). Outcome: PT was medically cleared by EMTs at 1708, provided with apple juice and instructions to drink/rest at home, exited facility on foot.


VAERS ID: 1441055 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Washington  
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 (MODERNA)) / MODERNA - / 2 RA / SC

Administered by: Private       Purchased by: ?
Symptoms: Incorrect route of product administration, Injection site swelling, Wrong technique in product usage process
SMQs:, Drug abuse and dependence (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: carvedilol ,clopidogrel, ezetimibe, fenofibrate, lisinopril, metformin, pravastatin, albuterol inhaler
Current Illness: CAD: STEMI with stent
Preexisting Conditions: hyperlipideia, pre-diabetes
Allergies: tetracycline penicillin
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Marked swelling R deltoid OE the swelling appears to be over-riding the deltoid muscle belly. My conclusion is that the vaccine was erroneously given SQ, causing excessive swelling.


VAERS ID: 1441072 (history)  
Form: Version 2.0  
Age: 19.0  
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 009D21A / 2 LA / IM

Administered by: Pharmacy       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 on pharmacy profile
Current Illness: Not indicated
Preexisting Conditions: None on pharmacy profile
Allergies: None on pharmacy profile
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Moderna vaccine was administered at 7hr and 15min after recommended 12-hr BUD time after first needle puncture. Bottle was kept at room temperature during this time. Patient was contacted 6 hours after receiving the vaccine and did not report any side effects at the time. A subsequent follow-up with patient was attempted the following day (today) but we were unable to reach patient.


VAERS ID: 1441095 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Oregon  
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 EW0164 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram, Headache, Myocarditis
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: melatonin, multivitamin, vitamin D, fluoxetine
Current Illness: no known illnesses
Preexisting Conditions: OCD and ADD
Allergies: no known allergies
Diagnostic Lab Data: EKG done IV Benadryl given intravenous
CDC Split Type:

Write-up: Mom called PCP office 6/30/21 about 4:00 and reported Cainan had a headache and mild chest pain. She brought him into the ED that evening. Mom called 7/1/2021 in the morning and informed us that he had been admitted to BAH for heart swelling. myocarditis


VAERS ID: 1441138 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Unknown  
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 EW0187 / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Neck pain, Pain, Vaccination site pain
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: goldenseal, vit D, magnesium
Current Illness:
Preexisting Conditions: none
Allergies: aspirin, latex, penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: pain at vaccine site on left arm, radiating to shoulder and neck


VAERS ID: 1441310 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Washington  
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 EW0181 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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
CDC Split Type:

Write-up: Patient came in for her second Moderna vaccine after 28 days and was accidentally given Pfizer vaccine instead . patient is in good spirits and feels ok. No reaction to getting mixed vaccine . doctor assured her safety of situation


VAERS ID: 1441338 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Alabama  
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 EW0182 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Dizziness, Dry mouth, Eye discharge, Eye pruritus, Fatigue, Groin pain, Head discomfort, Headache, Injection site erythema, Injection site pain, Injection site swelling, Mobility decreased, Nausea, Neck pain, Pain, Pain in extremity, Pain in jaw, Peripheral swelling, Pyrexia, Swelling, Tenderness, Toothache
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Osteonecrosis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Influenza with mild flu symptoms and pain, redness and swelling at the injection site as well as fever and fatigue.
Other Medications: B12 Omega-3 Vitamin C Vyvanse Fetzima Plaquinil Mycaphenolate Metoprolol Pepcid Protonix Ibuprofen Lamotrogine
Current Illness: One month prior: kidney stones and bladder infection
Preexisting Conditions: Systemic Lupus Erythematosus Rheumatoid Arthritis Scleroderma Osteoarthritis Paroxysmal Atrial Tachycardia
Allergies: Sulfa Lavender Wheat
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Dizziness about 30 minutes after. Approximately 6 hours after the injection site turned red, very swollen, very painful, difficult to lift and move arm and very sore to touch or apply pressure. Approximately 10 hours after the injection began having COVID symptoms with fever of 102.1, all over body aches, headache, nausea, very fatigued, dry mouth, itchy eyes and eye drainage, neck pain and tenderness on the left side and pain and swelling running up left arm into shoulders and neck. Also, my right arm was very sore and tender in the exact same spot as my left arm injection site. Pain in left jaw and teeth and right groin area. As of 26 hours later I have the same symptoms as listed above and my head feels very heavy like I can?t hold it up.


VAERS ID: 1441347 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Washington  
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 041C21A / 2 LA / IM

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

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

Write-up: Pt standing in post observation awaiting allotted time in post vaccination. Pt complaining to family members that the "room is spinning ". 1709 RN called and assessed alert man complaining of headache, denies breathing difficulty, lightheadedness, and nausea. EMTS called and arrived at 1710 Pt seated and BP 142/84 HR60 O2sat 97RA. Pt given H20 and resting in chair and monitored my EMTs. Pts symptom of dizziness is resolved and discharged at 1720.


VAERS ID: 1441360 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Virginia  
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 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dehydration, Headache, Lower respiratory tract infection, Oropharyngeal pain
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Infective pneumonia (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? 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: Brutal sore throat, feeling of a chest cold, heavy chest, mild headache, a feeling of constant and desperate dehydration even though urine runs clear.


VAERS ID: 1441533 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Ohio  
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 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: The vial had been initially punctured on 6/29/2021 and was kept in the refrigerator. The vaccine was drawn up on 6/30/2021 and administered.


VAERS ID: 1441688 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Colorado  
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 026C21A / 1 LA / IM

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

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

Write-up: There was no adverse symptoms, Patient did not disclose that she already had a Janssen COVID-19 injection on 4/10/2021. She reported she was here for her first Moderna vaccine. After trying to put the vaccine in CUREMD and send it to CISS, it came up that she already had Janssen injection. Called patient and she said yes she did recieve the Janssen injection, but her provider had wanted her to get a MRNA COVID-19 vaccine as a booster due to the variances and she is taking care of her frail ederly father, asked her which provider wanted her to have the injection, she then said it was really just a friend up in the front range that was an RN , she would not give a name. No further actions needed.


VAERS ID: 1441811 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Utah  
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 - / 2 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Blepharospasm, Injection site pain
SMQs:, Dystonia (broad), Extravasation events (injections, infusions and implants) (broad), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow)

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

Write-up: Constant eyelid twitch for nearly 24 hours and extreme soreness at injection site.


VAERS ID: 1441881 (history)  
Form: Version 2.0  
Age: 25.0  
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 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

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

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

Write-up: Patient complained of dizziness following vaccination. Patient was placed in a supine position with legs elevated. Patient''s blood pressure was checked and reported at 110/70. After a few minutes patient reported feeling fine. Patient was observed for 15 minutes then released to her husband.


VAERS ID: 1441897 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-29
Onset:2021-06-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 2 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Chills, Dizziness, Laboratory test, Oropharyngeal pain
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: N/A
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data: ROS HEENT: no runny nose, no eye pain, no ear pain CV: no chest pain, no palpitations Resp: no shortness of breath, no cough, no pleurisy Abd: abdominal pain as above but no N/V/D, nROS HEENT: no runny nose, no eye pain, no ear pain CV: no chest pain, no palpitations Resp: no shortness of breath, no cough, no pleurisy Abd: abdominal pain as above but no N/V/D, no hematuria/dysuria MSK: no joint pain, no joint swelling, no back pain PE Gen: A&Ox4, NAD, speaking in full sentences HEENT: EOMI with conjugate gaze, no facial trauma, no AOM/OE/Ludwig''s, no cervical adenopathy CV: S1/S2 RRR no MRG Pulm: CTA all fields, no dyspnea, unlabored respirations GI: no focal TTP, no peritoneal signs, negative Rovsing''s, no tenderness to palpation at McBurney''s, negative psoas and obturator MSK: moving all extremities equally 5/5 strength, no deformities, no joint effusions Neuro: CN 2-12 intact, cerebellar intact, DTR 2/4 bilat patellar, no clonus Labs: Rapid strep: neg Throat culture: pending Rad: none indicated MDM: This is not likely CVA/TIA, RPA/PTA/Ludwig''s, PE, ACS, appendicitis, testicular torsion, ureterolithiasis or pyelonephritis.
CDC Split Type:

Write-up: pt presents to the ED for sore throat, chills and dizziness that he attributes to the second dose of the Moderna vaccine which he received on 29Jun2021 at 1400.


VAERS ID: 1441898 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-29
Onset:2021-06-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 2 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Chills, Headache, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: ADHD
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data: General: Non-toxic, well appearing, in no acute distress, and appears stated age and well developed and well nourished. Vital Signs: Normal. Head: Normocephalic and atraumatic. General: Non-toxic, well appearing, in no acute distress, and appears stated age and well developed and well nourished. Vital Signs: Normal. Head: Normocephalic and atraumatic. Eyes: Aproptotic, extraocular movements intact, and pupils equally round. Nose: Nares with evidence of rhinorrhea. Ears: TM and EAC normal bilateally. No mastoid erythema or tenderness. Throat: No posterior erythema or exudates. Mucus membranes moist. Face: No sinus tenderness. Neck: Supple without menigismus without lympadenopathy. Heart: Regular rate and rhythm without murmur, gallops, or rubs. Lungs: Clear to auscultation without wheezing, rales, or rhonchi. Neurological: Alert and oriented. Gait normal. Psychiatric: Normal affect and non-tearful Extremities: no cyanosis or edema. No calf tenderness. Skin: no rashes, ecchymosis, or lesions.
CDC Split Type:

Write-up: 24 year old otherwise healthy male presents to the emergency room with complaints of chills, myalgias, and mild headache beginning last night after receiving the second shot of the Moderna COVID-19 vacination. The patient denies fevers, abdominal pain, leg pain, weight loss, night sweats, worst headache of life, sick exposures, or recent travel. Symptoms consistent with expected post vaccination reaction following the 2nd Moderna COVID-19 vaccination. No evidence of life threatening pathology and doubt pneumonia, myocardial infarction, pneumothorax, meningitis, PE. Patient tolerating oral fluids and solids without difficulty. Will treat symptomatically, place on 48 hours quarters, and arrange follow up with primary care practitioner. The patient was given strict return precautions and was comfortable with the plan. Discharged to a safe ride home.


VAERS ID: 1441899 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-29
Onset:2021-06-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 2 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Chills, Headache, Musculoskeletal stiffness, Oropharyngeal pain
SMQs:, Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (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: UNK
Current Illness: Seasonal Allergic Rhinitis
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data: General: Non-toxic, well appearing, in no acute distress, and appears stated age and well developed and well nourished. Vital Signs: Normal. Head: Normocephalic and atraumatic. General: Non-toxic, well appearing, in no acute distress, and appears stated age and well developed and well nourished. Vital Signs: Normal. Head: Normocephalic and atraumatic. Eyes: Aproptotic, extraocular movements intact, and pupils equally round. Nose: Nares without evidence of rhinorrhea. Ears: TM and EAC normal bilateally. No mastoid erythema or tenderness. Throat: No posterior erythema or exudates. Mucus membranes moist. Face: No sinus tenderness. Neck: Supple without menigismus without lympadenopathy. Heart: Regular rate and rhythm without murmur, gallops, or rubs. Lungs: Clear to auscultation without wheezing, rales, or rhonchi. Neurological: Alert and oriented. Gait normal. Psychiatric: Normal affect and non-tearful Extremities: no cyanosis or edema. No calf tenderness. Skin: no rashes, ecchymosis, or lesions. Symptoms consistent with expected post vaccination reactions/symptoms. No evidence of life threatening pathology and doubt pneumonia, myocardial infarction, pneumothorax, meningitis, PE. Patient tolerating oral fluids and solids without difficulty. Will treat symptomatically, place on quarters x 24 hours, and arrange follow up with primary care practitioner. The patient was given strict return precautions and was comfortable with the plan. Discharged to a safe ride home.
CDC Split Type:

Write-up: Pt reports to ED 1day s/p now w/ L arm stiffness, sore throat, HA, "shivers and chills" w/o relief s/p motrin.


VAERS ID: 1442380 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Arizona  
Vaccinated:0000-00-00
Onset:2021-06-30
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: 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: USJNJFOC20210700341

Write-up: TINY RED SPOTS ON BODY; This spontaneous report received from a patient concerned a female of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 30-JUN-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 30-JUN-2021, the subject experienced tiny red spots on body. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of tiny red spots on body was not reported. This report was non-serious.


VAERS ID: 1442795 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Improper Storage (temperature)-


VAERS ID: 1442850 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939676 / 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? 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 Dose of Vaccine - Too Low-


VAERS ID: 1443010 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 0W0181 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Ear discomfort
SMQs:

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

Write-up: Ear fullness/pressure onset within 8 hours of 2nd dose. Unilateral, on Left side, same as vaccine administration. No prior ear conditions or hearing difficulties prior to this event. Still experiencing this adverse event at time of reporting.


VAERS ID: 1443042 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Vermont  
Vaccinated:2021-06-28
Onset:2021-06-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood potassium decreased, Chest pain, Dyspnoea, Echocardiogram abnormal, Ejection fraction, Electrocardiogram ST segment elevation, Hepatic steatosis, Myocarditis, Pericarditis, Pleuritic pain, Troponin I increased, Ultrasound abdomen abnormal
SMQs:, Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Hypokalaemia (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: melatonin
Current Illness: none
Preexisting Conditions: autism
Allergies: NKDA
Diagnostic Lab Data: ST elevation on EKG. Trop-I 12.4, 25, 24.1, 23.8 echocardiogram EF 50-55%. K 3.4, ALT-171, AST - 74 ultrasound RUQ - moderate diffuse hepatic steatosis
CDC Split Type:

Write-up: 2 days s/p second Pfizer vaccine (6/7 and 6/28) patient presented to ED with pleuritic chest pain and difficulty breathing. Diagnosis myo / pericarditis. Transferred to MC start treatment with colchicine, lisinopril, metoprolol,


VAERS ID: 1443052 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-02
Onset:2021-06-30
   Days after vaccination:89
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zocor, Klonopin, Prilosec, Estrace, Lisinopril, Tums, vitamin D3, aspirin, acetaminophen, aleve
Current Illness: NA
Preexisting Conditions: Hypercholestrememia, Restless leg syndrome, essential hypertension, GERD, elevated blood sugar.
Allergies: NKA
Diagnostic Lab Data: PCR COVID-19 Test
CDC Split Type:

Write-up: Patient tested positive for COVID-19 on 07/01/2021. Developed symptoms on 06/30/2021


VAERS ID: 1443070 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3001658 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA9094 / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: Heart rate increased, Hypoaesthesia, Loss of consciousness, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (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), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Increase in heart rate (160), both arms became numb, vomiting, loss of consciousness. Was transferred to ER.


VAERS ID: 1443087 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-29
Onset:2021-06-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / -

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

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

Write-up: Headache,fever, nausea


VAERS ID: 1443145 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-29
Onset:2021-06-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH WE0196 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Breast discharge, Headache, Nausea, Vaginal infection, Vulvovaginal rash
SMQs:, Severe cutaneous adverse reactions (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (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: Prenatal Vitiman , Omega-3, Iodine, CoQ10
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaginal infection/rash. Puss discharge from right nipple. Headache. Nausea.


VAERS ID: 1443150 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-29
Onset:2021-06-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest X-ray, Chest discomfort, Chest pain, Electrocardiogram, Full blood count
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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluoxetine, Nuvaring, Qvar inhaler, desloratadine 5mg, zolmitriptan 5mg, Astelin nasal spray 0.1%
Current Illness: none
Preexisting Conditions: Allergies, migraines
Allergies: Cefdinir, peanuts, nuts
Diagnostic Lab Data: EKG (6/30/21), CBC (6/30/21), x-ray of heart
CDC Split Type:

Write-up: Patient exhibited symptoms for myocarditis. She also had chest pains, and a crushing sensation in her chest. These symptoms began in the middle of the night on June 30, 2021. Worsened in the morning and patient went to E.R. Patient received toradol and i.v. fluids and was monitored. Symptoms resolve after approximately 4 hours. Today she is feeling fine.


VAERS ID: 1443175 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-01
Onset:2021-06-30
   Days after vaccination:60
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Deep vein thrombosis, Oedema peripheral, Ultrasound Doppler
SMQs:, Cardiac failure (broad), Angioedema (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? Yes
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: RLE venous evaluation on 07-01-2021.
CDC Split Type:

Write-up: RLE edema started on 6-30-2021. Extensive RLE deep vein thrombosis was diagnosed through the ER. Due to the extensive DVT, this has been growing for longer than the symptoms have shown.


VAERS ID: 1443192 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-28
Onset:2021-06-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Paraesthesia, Skin discolouration
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (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: Refused to provide anything but necessary fields.
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Neck started turning black, tingling in breast and nipples


VAERS ID: 1443194 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-06-29
Onset:2021-06-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Headache, Hyperhidrosis, Nausea, Rash, Urticaria
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Benadryl
Current Illness: No
Preexisting Conditions: Ciliac Disease
Allergies: Gluten, percocet
Diagnostic Lab Data: Pending labs : labs were done 7/1/21
CDC Split Type:

Write-up: Rash/Hives, Chest pain, Sweating, shortness of breath, headache and nausea. Patient went to PCP and was given Prednisone, Benadryl and other lab tests performed to evaluate status of patient. Patient is home and was only seen at PCP outpatient clinic


VAERS ID: 1443199 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-05-25
Onset:2021-06-30
   Days after vaccination:36
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Exposure during pregnancy, Foetal death, Foetal hypokinesia, Headache, Induced labour
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Foetal disorders (narrow), Termination of pregnancy and risk of abortion (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Subjective: 33-year-old G4 P3 @36w5d presents for admission due to fetal demise diagnosed in clinic earlier today. Her pregnancy is complicated by hypothyroid, obesity, h/o LTCS with subsequent VBAC x 2, h/o GDM with normal screen this pregnancy, h/o preeclampsia in prior prgnancy, COVID this pregnancy. PNC with doctor. Patient called the office this morning noting lack of fetal movement. She believes she felt baby last night but is unsure. Possibly the last time was this weekend. She denies contractions, vaginal bleeding, LOF, fever, chills. Has mild HA now but that just started since being admitted. BP in office 160/94. Now normal.


VAERS ID: 1443204 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Sinus tachycardia, Taste disorder, Throat irritation
SMQs:, Anaphylactic reaction (broad), Taste and smell disorders (narrow), Supraventricular tachyarrhythmias (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ascorbic acid, atorvastatin Betaxolol, empagliflozin, insulin, nortriptyline
Current Illness:
Preexisting Conditions:
Allergies: PATIENT IS ALLERGIC FLOOR CLEANER/ STRIPPING DETERGENTS. Brimonidine- red and itchy eyes
Diagnostic Lab Data: Sinus Tachycardia with occasional Supraventricular premature complexes
CDC Split Type:

Write-up: History provided by: Patient (NURSES) Unable to obtain history due to : Acuity of condition Allergic Reaction Presenting symptoms: no difficulty breathing, no difficulty swallowing, no itching, no rash, no swelling, no wheezing, no dizziness and no syncope Presenting symptoms comment: SEVERE COUGHING WITH IRRITATION OF THROAT AND WEIRD TASTE IN MOUTH AFTER COVID VACCINE WAS GIVEN TO THE PATIENT.DENIES THROAT CLOSING OR WHEEZING IN CHEST OR OROPHARYNGEAL SWELLING.NO HIVES. Severity: Severe Duration: 2 minutes Prior episodes: PATIENT IS ALLERGIC FLOOR CLEANER/ STRIPPING DETERGENTS. Context: medications (specify) Context: not animal exposure, not cosmetics, not dairy/milk products, not eggs, not food allergies, not grass, not insect bite/sting, not jewelry/metal, not new detergents/soaps, not nuts and not poison ivy Worsened by: Nothing Relieved by: Nothing Ineffective treatments: None tried Treated with epinephrine, methylprednisolone, diphenhydramine dexamethasone and multiple nebulizers


VAERS ID: 1443210 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-29
Onset:2021-06-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Delirium, Laboratory test normal, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient with fevers, myalgias, and delirium. Required hospitalization for infectious work up which has been negative to date. Now improving and still hospitalized.


VAERS ID: 1443221 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0146 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Adverse reaction, Injection site reaction, 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: The patient had received the Janssen vaccine already. No boosters are required for this vaccine. The patient stated that he wanted to get a Pfizer dose as a booster. He was from (country) and that is what they are doing there. The technicians refused and said boosters on Janssen are not allowed. The patient then spoke with the pharmacist and he decided to give the booster anyway even though it is not allowed on the EUA or by company policy. Pharmacist will receive coaching and counseling for give incorrect boosters. Schedule of covid vaccine was reviewed with all staff. Patient had minor injection site reaction and normal covid vaccine side effects.


VAERS ID: 1443223 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 1 LA / IM

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

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

Write-up: Pt was vaccinated w/ Pfizer 6/30/21 after receiving Janssen 042A21A on 4/2/21. Pt had no complaints in observation. Pt stable and released from the vaccination site.


VAERS ID: 1443230 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-23
Onset:2021-06-30
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 1 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Joint stiffness, Musculoskeletal stiffness, Pain in extremity, Peripheral swelling, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Arm swelling, hot to the touch and it is red, and on the way here her arm started to hurt, it is an achy, stiff muscle in her joint and it hurt down to her left wrist.


VAERS ID: 1443303 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-29
Onset:2021-06-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939676 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Pain
SMQs:

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

Write-up: Systemic: Body Aches Generalized-Severe


VAERS ID: 1443400 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-29
Onset:2021-06-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Vertigo positional
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (narrow)

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

Write-up: Patient received Johnson & Johnson on 6/29 (lot # 205A21A). He presented to the ED on 6/30 with complaint of dizziness. Patient said he felt that the room was spinning every time he sat up or stood up. Patient denied any history of vertigo in the past.


VAERS ID: 1443430 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-06-29
Onset:2021-06-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Centrum One a day Vitamins, Garlic, D3, B12 and Vitamin C
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Greatly swollen Lymph Node under the injection arm. Went to urgent care at Hospital and was instructed to take Vitamin C and Zinc. Warm compress and to alternate between Ibuprofen and Acetaminophen. Monitor after a few days and if the swelling does not go down, go to my primary care practitioner to make sure it is not cancer or cancerous.


VAERS ID: 1443560 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043B21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Chest discomfort, Dyspepsia
SMQs:, Anaphylactic reaction (broad), Gastrointestinal nonspecific dysfunction (narrow), Arthritis (broad)

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

Write-up: Pt c/o chest pressure, heartburn, R - shoulder pain 10 mins after vaccination -- $g relieved w/ rest and decreased environmental stimuli. BP 168/56, HR 72, RR 18 SPO2 100% -- $g 129/78, 78,18, 100% -- $g 146/80,69, 18, 99% . Pt stable and released from vaccination site w/ family. Pt had steady gait. Pt was advised to f/u w/ her provider and seek ER if symptoms return or worsen.


VAERS ID: 1443943 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-06-26
Onset:2021-06-30
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Bell's palsy
SMQs:, Hearing impairment (broad)

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

Write-up: Bell''s Palsy


VAERS ID: 1444380 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia
SMQs:, Arthritis (broad)

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

Write-up: Sharp pain behind knee cap lasting 24 hours


VAERS ID: 1444726 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-06-03
Onset:2021-06-30
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: received vaccines 5/13/21 and 6/3/21 and tested positive 7/1/2021
CDC Split Type:

Write-up: Covid infection after full vaccination


VAERS ID: 1445723 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-06-30
Submitted: 0000-00-00
Entered: 2021-07-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN HT365 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Eyelids pruritus, Fatigue, Feeling abnormal, Headache, Lymphadenopathy, Nausea, Pain, Paraesthesia, Pollakiuria, Pruritus
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Dementia (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Neuropathy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210702550

Write-up: ITCHING OF EYELIDS; GLANDS ARE SWOLLEN BETWEEN TEMPLES AND EARS; INCREASED BATHROOM USE; HURT ALL OVER; TINGLING ON LEFT SIDE; ITCHING OF EYEBROW/ITCHING; FEEL LIKE EATEN A SOUR CANDY; GOT NAUSEATED; HEADACHE; TIRED; This spontaneous report received from a patient concerned a 63 year old of unspecified sex. The patient''s height, and weight were not reported. The patient''s concurrent conditions included neuropathy. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: HT365, and expiry: 03/AUG/2021) dose was not reported, administered on 30-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 30-JUN-2021, the subject experienced itching of eyelids. On 30-JUN-2021, the subject experienced glands are swollen between temples and ears. On 30-JUN-2021, the subject experienced increased bathroom use. On 30-JUN-2021, the subject experienced hurt all over. On 30-JUN-2021, the subject experienced tingling on left side. On 30-JUN-2021, the subject experienced itching of eyebrow/itching. On 30-JUN-2021, the subject experienced feel like eaten a sour candy. On 30-JUN-2021, the subject experienced got nauseated. On 30-JUN-2021, the subject experienced headache. On 30-JUN-2021, the subject experienced tired. Treatment medications included: diphenhydramine hydrochloride. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the itching of eyelids, glands are swollen between temples and ears, tired, got nauseated, increased bathroom use, hurt all over, headache, tingling on left side, itching of eyebrow/itching and feel like eaten a sour candy was not reported. This report was non-serious.


VAERS ID: 1446054 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Injected limb mobility decreased, Pain in extremity
SMQs:, 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: Multivitamin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: A few hours after receiving my first shot my right arm started to hurt. It was difficult to raise my arm. I also experienced fatigue. I went to bed that night at 7:00pm due to be so tired. I took Tylenol for the arm pain. I woke up the next morning with my arm still hurting and still feeling tired. The tiredness continued throughout the day. The arm pain subsided by that evening (7/1/2021 around 7:00 pm). The tiredness is getting better, but I?m not yet back to my energetic self as of this morning (7/3/2021)


VAERS ID: 1446081 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY0584 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, 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: Systemic: Numbness (specify: facial area, extremities)-Mild, Systemic: Tingling (specify: facial area, extemities)-Mild, Additional Details: By the time the patient left she stated that the tingling sensation and numbness was less dominant


VAERS ID: 1446135 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-01
Onset:2021-06-30
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-07-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Injection site pruritus, Rash erythematous, Vaccination site reaction, Vaccination site swelling
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: Lupron Depot. Vitamin supplements: magnesium, vitamins C, D, fish oil, biotin, probiotics
Current Illness:
Preexisting Conditions: Endometriosis
Allergies: Allergy to penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Red rash at the vaccination spot, swelling and itching at the vaccination spot


VAERS ID: 1446160 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event, Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: no AE, storage error


VAERS ID: 1446173 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-06-29
Onset:2021-06-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Injection site pain, Myalgia, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Extreme muscle pain, chills, headache over right eye, fatigue, nausea, arm soreness at injection x 24 hours


VAERS ID: 1446191 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-29
Onset:2021-06-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Myocarditis
SMQs:, Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Myocarditis with symptom onset one day after receiving second dose of COVID Pfizer vaccine


VAERS ID: 1446193 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-29
Onset:2021-06-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: VACCINE IN FREEZER LONGER THAN CDC GUIDELINES


VAERS ID: 1446200 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: VACCINE IN FREZER LONGER THAN CDC GUIDELINE


VAERS ID: 1446224 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: VACCINE IN FREEZER LONGER THAN CDC GUIDELINES


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