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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 75 out of 5,069

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VAERS ID: 1433472 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), 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: with the first dose of the Pfizer vaccine on 6/8/21
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: poultry
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: shortly after receiving the vaccine the patient passed out briefly in the waiting area, He quickly came to and did not want us to call 911


VAERS ID: 1433489 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Coreg 6.25mg x2, Clopidogrel 75mg, Losartan, Entresto 45mg, Aspirin 81mg, Lipitor 40mg, Fish Oil, Super B vitamins, Vitamin C
Current Illness: N/A
Preexisting Conditions: HBP, Defibrillator
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt.''s wife states 06/29/2021 husband received Phizer vaccine 10:00am and then was notified of receiving 6x the normal dosage required @ 11:00am. No known symptoms presently presently (currently under supervision).


VAERS ID: 1433526 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-03
Onset:2021-06-29
   Days after vaccination:57
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: No symptoms


VAERS ID: 1433538 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C214A / 2 RA / IM

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

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

Write-up: Patient had Pfizer for first vaccine on 06/02/21 and received Moderna for a second dose 06/29/21.


VAERS ID: 1433550 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Pfizer COVID-19 vaccine administered 8 days before the patient''s 12th birthday. Checked CDC information following vaccination to determine appropriate course of action. Will complete the series after patient turns 12 as scheduled.


VAERS ID: 1433633 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 1 LA / IM

Administered by: Senior Living       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: Lexapro
Current Illness: no
Preexisting Conditions: no
Allergies: none
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 1st dose Moderna accidentally given to a 16 year old


VAERS ID: 1433637 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

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

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

Write-up: ADMINISTRATION ERROR, PATIENT WANTS JOHNSON AND JOHNSON BUT WE GAVE PFIZER


VAERS ID: 1433638 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Injection site pain, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad)

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

Write-up: Gross motor weakness distally in Left Upper Extremity within 1-2 minutes after receiving COVID 19 (Janseen) injection in left bicep muscle. Pain in biceps muscle with passive elbow flexion. Sensation intact to light touch across all limb. Motor function in Anterior Interosseus nerve, Posterior Interosseus Nerve and ulnar nerve intact in Left hand although weak (relative to normal contralateral limb). Vascular exam normal distally, with strong pulses in radial/ulnar arteries. Patient was evaluated by onsite physician and sent to the Emergency Room via EMS.


VAERS ID: 1433653 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER9736 / UNK 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: 6/29/2021 Patient was observed post Covid-19 immunization for 15 minutes . During the observation period, she experienced an adverse reaction with the following symptoms: dizziness. Assessment : Time of assessment 142pm. Alert and oriented and dizziness. Actions taken: Vitals sign taken VAERS form obtained and completed by RN. 142pm- BP 148/100 _79, O2 99%, water given, kept in observation x 30 minutes. Recheck VS- BP- 140/88, P- 76, O2- 98 %, reports feeling better, recheck VS sitting- BP- 134/87, P- 72, O2- 99% , standing BP- 132/88, P- 84, O2- 99% Medications administered: No medication administered. Disposition: Reports no further symptoms of adverse reaction after observation for 30 minutes. Discharged home. Husband with patient. Immunizations Administered Name Date Dose Date Route Pfizer COVID-19 Vaccine 6/29/2021 1:17 PM 0.3 mL 2/25/2020 Intramuscular Manufacturer: Pfizer, Inc Lot: ER8736


VAERS ID: 1433690 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-17
Onset:2021-06-29
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 22B21A / 1 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angiogram pulmonary normal, C-reactive protein increased, Chest pain, Chills, Electrocardiogram abnormal, Fibrin D dimer, Pain, Red blood cell sedimentation rate increased, Supraventricular extrasystoles, Troponin increased
SMQs:, Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol, aspirin 81, clopidogrel 75mg, insulin, isosorbide mononitrate 30mg, levothyroxine 175 mcg, lisinopril 20mg, metoprolol 50 mg, Nifedical XL 60mg, rosuvastatin, 40mg, Trulicity.
Current Illness:
Preexisting Conditions: CAD, prev. CABG, stenting, DM, HTN, HLD, hypothyroidism
Allergies: no known allergies
Diagnostic Lab Data: Elevated CRP 140, ESR 74, troponin went from 0.06 to 0.10 to 0.12, D-dimer 1,970 but CTPE negative for P.E. ECG with frequent APCs in bigeminal pattern.
CDC Split Type:

Write-up: Ache, chills, and atypical right sided chest pain. Started 1 day after shot and 12 days later pt. came to hospital with chest pain.


VAERS ID: 1433723 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 RA / IM

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

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

Write-up: Syncope


VAERS ID: 1433727 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient received 2nd dose of COVID 19 vaccine series. Patient was supposed to receive Moderna vaccine and instead received Pfizer vaccine. No immediate anaphylaxis or other side effects were present after the patient received the vaccination.


VAERS ID: 1433729 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-28
Onset:2021-06-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Disturbance in attention, Dizziness
SMQs:, Anticholinergic syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Patient called pharmacy 6-29-21 at 2:15PM. Patient states she has been having chest pain. difficulty concentrating, and dizziness today. Advised patient to go to the Emergency Room due to chest pain.


VAERS ID: 1433784 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 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: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Patient was supposed to receive Moderna vaccine for 2nd dose of COVID-19 Vaccine series. Patient inadvertently received Pfizer vaccine instead. The dose give was appropriate for the Pfizer vaccine, and the patient did not experience any immediate adverse events.


VAERS ID: 1433790 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

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

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: ADHD
Allergies: NKA
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient received #1 dose of Pfizer vaccine today 6/29/2021 at 1:47 pm. Patient spent 15 minutes in observation room without exhibiting any signs or symptoms of any adverse reaction. Patient left observation room with parent and siblings and entered elevator near the check in desk of the clinic. Patient found laying in elevator on floor after staff arrived due to mother calling for help. Parent reports that patient passed out and fell to ground. Patient was conscious. Patient taken to observation room via wheelchair once determined that patient was fully awake. 911 called. Vital signs obtained at 2:10 pm BP 98/42 P 77 O2 Sat 100% . Patient transported to hospital with parent via 911 for further observation.


VAERS ID: 1433799 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-03-13
Onset:2021-06-29
   Days after vaccination:108
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram thorax, Cough, Pulmonary embolism
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, venous (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: morbid obesity, varicose veins, adrenal adenoma
Preexisting Conditions: as above
Allergies: nsaids, aleve, theraflu, EES, mycins, tamiflu
Diagnostic Lab Data: CT scan chest
CDC Split Type:

Write-up: patient presents to the ER with 2 to 3 month history of cough which started 2 weeks after vaccination. diagnosed with bilateral pulmonary emboli - no other precipitating cause identified


VAERS ID: 1433807 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: The mother put the current date instead of the child''s birth date. When checked in MICR her birth date is 3 days from now.


VAERS ID: 1433816 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-06-21
Onset:2021-06-29
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Aortic aneurysm, Cardiac failure acute, Cardiac failure congestive, Computerised tomogram
SMQs:, Cardiac failure (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol inhaler, albuterol-ipratropium 0.5-2.5 mg/3 ml, almodipine 5 mg, Eliquis 5 mg, aspirin EC 81 mg, Lipitor 80 mg, Symbicort 160-4.5 mcg/act, carvedilog 6.25 mg, Zetia 10 mg,
Current Illness: 6/5/2021 - UTI, bacterial - ER visit on 6/5/2021
Preexisting Conditions: Acute on chronic diastolic heart failure, benign essential hypertension, status post coronary artery bypass grafting, chronic anticoagulation, Diabetes mellitus Type 2, diet-controlled, persistent atrial fibrillation, COPD, coronary artery disease, acute respiratory failure with hypoxia., ejection fraction of 64% in 2019, atrial fibrillation
Allergies: Levaquin
Diagnostic Lab Data: CT Scan
CDC Split Type:

Write-up: acute congestive heart failure, dilatation of thoracic aortic aneurysm to 4.4 cm


VAERS ID: 1433827 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 2 - / IM

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

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

Write-up: The patient received Moderna on 4/29/2021 as an IM injection. The patient was due to receive a second dose and was inadvertently given Johnson and Johnson as a second shot on 6/29/2021. We immediately recognized. A medical physician and nurse called and spoke with patient''s daughteron a virtual call. The home health nurse was also present, Comfort. The patient''s vital signs were stable before and after the vaccine was administered. We have a plan to contact the patient weekly for the next four weeks to ensure he has no adverse reactions. We will also send a new vaccination card with the correct information.


VAERS ID: 1433831 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / IM

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

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

Write-up: post vaccine client started to vomit. history of anxiety. NP and EMT on site, evaluated client. Zofran sublingual given by EMT. Vomitted again imediately after. client in observation for 30 mins, felt better after and left with parent at her side


VAERS ID: 1433836 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immediate post-injection reaction, Loss of consciousness, Nausea, Paraesthesia
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), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: A few minutes after injection the patient reported feeling nauseous. Had patient sit back down where he then passed out. Checked for pulse and breathing asked patient if he could respond to me. Within 15 second patient was able to respond to me. After about a minute patient color came back and was able to open eyes and look at me. Patient then complained of not be able to feel his hands and feet which feeling came back after a few minutes. However patient still complained of feeling pins and needles in his fingers. After 20 to 30 minutes patient reported feeling ok and was released under parents care.


VAERS ID: 1433849 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-17
Onset:2021-06-29
   Days after vaccination:73
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Axillary pain, Computerised tomogram thorax, Hypoaesthesia, Immediate post-injection reaction, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: CT scan of chest pending
CDC Split Type:

Write-up: Pain at the BL axilla and numbness and tinging at hands. Began immediately following the injection and worsened in subsequent weeks.


VAERS ID: 1433881 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Feeling abnormal, Feeling of despair, Musculoskeletal stiffness, Peripheral venous disease, Tenderness, Vasodilatation
SMQs:, Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None administered primary care physician prescribed Tylenol and to wait for it to get better. Has not returned phone calls requesting referral to specialist.
CDC Split Type:

Write-up: Normal side effects at first. 72 hours after shot extreme pain in joints. Pain resolved everywhere but forearms, wrists, and hands. Currently, blood pooling in thumb joints, tenderness in wrists and fingers, stiffness in hands wrists, and forearms. Heat and sense of hardness in veins. Veins sticking out in forearms and thumbs. 13 weeks since vaccination. Primary Care physician unresponsive. Limited use of hands. Psychological despair setting in.


VAERS ID: 1433883 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Flushing, Pallor, Visual impairment
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (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: After giving the vaccine, patient complained of a flushing feeling across her body. While waiting for 15 minutes after the vaccine, patient began to feel light headed and dizzy. She complained that her vision became cloudy. Her color was extremely pale and said she felt like she was going to pass out. We gave her a bottle of water and a bottle of orange juice. I sat with her and her mother to monitor her. After drinking most of the juice, she began to feel better and her vision was back to normal. She never lost consciousness. After about 30 minutes, she felt well enough to leave.


VAERS ID: 1433896 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac discomfort, Malaise, Scan
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: The patient has a pacemaker and defibrillator.
Preexisting Conditions: The patient has heart problems. He has a pacemaker and defibrillator.
Allergies:
Diagnostic Lab Data: The emergency care workers checked his blood pressure and they performed a scan. Everything was okay, Pt was told to follow up with with regular physician. Pt said that he would.
CDC Split Type:

Write-up: Pt complained of not feeling well about 10 minutes after the Moderna vaccination. He complained of heart issues. I asked him if he wanted me to call an ambulance. He wanted to wait. A few minutes later he asked me to call an ambulance. The Pharmacy associate called the ambulance. During the wait for t he ambulance, I monitored him and he drank a little water. Pt called his partner. The ambulance arrived about 15 minutes later. He was calmer and felt better. He was evaluated and they left. Pt left soon after the emergency care workers. I have been unable to contact Pt for a follow-up.


VAERS ID: 1433911 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

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

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

Write-up: Vaccine given at 9:43 am. Patient passed out and hit the ground at 9:50am, sat her up against the wall on the floor. She complained of being hot and we gave her cold water and an ice pack. She started feeling better around 9:55 am and asked to leave at 10 am.


VAERS ID: 1433914 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-28
Onset:2021-06-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: DM2, GERD
Allergies: Bee allergy
Diagnostic Lab Data:
CDC Split Type:

Write-up: 15 minutes after injection patient developed a rash that continued to spread. Itching but patient denied shortness of breath, swelling to lips. Patient treated with diphenhydramine 25 mg /10 ml by mouth at time 15:05. Patient symptoms resolved and discharged home after observation.


VAERS ID: 1433917 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 RA / IM

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

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

Write-up: At 2:45 pm I was informed that a 12-year-old who had just been given the vaccine was dizzy. I went to get a cotton ball with alcohol and immediately went out to assist him. After a few minutes he indicated that he felt better. The nursing graduate came out to check it again and was dizzy again. His arms were raised, ice was placed on him, then we put him on several chairs with his legs raised by pillows and 911 was called at 3:01 pm. The patient presented a complaint of tingling in the face and arms. The pressure was taken (126/76) Pulse 84. The father requests a stethoscope because he feels the young man''s heart agitated and an oximeter since it also indicates some difficulty in breathing. Oxygen is placed and oximeter reflects a saturation of 99%. BP: 124/65. 911 is called back at 3:20 pm. They arrived at 3:26 pm. Paramedic indicated to give him liquid Benadryl. He was given 10ml. They proceeded to take the young man to the Hospital.


VAERS ID: 1433927 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 1 LA / IM

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

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

Write-up: After receiving first PFIZER brand COVID-19 vaccine patient had a syncope episode in clinic. After leaving exam room, while walking to appointment desk, patient stated that she may have stood up too fast and needs to sit down. Nurse sat patient in near by nurse chair. Patient then closed eyes and became limp. With the help of, RMA, LPN and patient''s mom patient was assisted to a supine position on the floor with patient''s head and neck supported the entire time. Within 3-5 seconds patient''s eyes opened and she began speaking clearly AAAx3. Cool rags placed on forehead. Patient supported in this position for about 3-5 minutes then assisted to a seated position. Cup of water and sucker given. Patient actively talking with nursing staf and mom. After several more minutes patient assisted and ambulated to exam room. Patient on exam table in supine position for aprox 15 mins then seated for 15 mins before arrived. Patient cleared for discharged per. Patient ambulated to vehicle without difficulty. Mom advised to call with any questions or concerns. VSS b/p 97/59 HR60 Pox 96-100% , LPN Care Coordinator


VAERS ID: 1433931 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY0584 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dehydration, Immediate post-injection reaction, Loss of consciousness, Skin abrasion
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Hypoglycaemia (broad), Dehydration (narrow)

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

Write-up: Patient passed out immediately after receiving Pfizer COVID 19 vaccine with recovery within 1 minute. Sustain skin abrasions on left forehead and upper outside of face. Noted by nurse was at party 6/28/21 and drinking. Drove 2 hours from other state prior to receiving vaccine. Probably dehydrated.


VAERS ID: 1433940 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21 / 1 UN / IM

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

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

Write-up: weakness, dizziness for about 2 minutes at that time BP 97/67 pt observed for additional 30 minutes bp at that time 112/70, left with family no LOC observed


VAERS ID: 1433942 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH CW3112 / 1 RA / IM
UNK: VACCINE NOT SPECIFIED (OTHER) / UNKNOWN MANUFACTURER U6935AA / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose normal, Dizziness, Headache, Pain in extremity, Pallor, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE KNOWN
Preexisting Conditions: NONE KNOWN
Allergies: NUTS AND PEANUTS
Diagnostic Lab Data: PATIENT TAKEN TO TREATMENT ROOM AND LAID ON EXAM TABLE. VITALS ASSESSED 1226: 102/60-92-18-98% o2 SAT. PATIENT ASSESED BY PROVIDERS, CPNP. BLOOD GLUCOSE 77. PATIENT ALERT AND ORIENTED X 5 THE ENTIRE TIME. VITALS ASSESED 1234 114/64-80-18 98%. TEMP 37.5 PATIENT''S SHAKING HAD CEASED, COLOR HAD RETURNED AND PATIENT WAS REPORTING FEELING BETTER. 1240 PATIENT WAS ASSISTED TO A SITTING POSITION AND GIVE SOME WATER. PATIENT CONTINUED TO REPORT IMPROVEMENT OF SYMPTOMS. 1247 PATIENT FELT WELL ENOUGH TO STAND, SHE WAS ASSISTED TO A STANDING POSITION AND REPORTED NO SX OF DIZZINESS OR LIGHTHEADEDNESS. PATIENT WAS DISCHARGED HOME WITH DAD WITH INSTRUCTIONS TO EAT, HYDRATE, REST AND TO CALL OFFICE WITH FURHTER CONCERNS.
CDC Split Type:

Write-up: PATIENT RECEVIED VACCINES AT 1050 IN OUR OFFICE, PATIENT WAITED 30 MINUTES AFTER VACCINES WITH NO S/SX OF REACTIONS. AT 1220 DAD CAME IN WITH PATIENT WHO WAS REPORTING FEELING DIZZY, HEADACHE, FEELING LIGHT HEADED. PATIENT WAS HAVING A HARD TIME KEEPING EYES OPEN. CLOSE TO PASSING OUT. PATIENT WAS SHAKING AND PALE. ALSO C/O ARM PAIN


VAERS ID: 1433947 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-06-28
Onset:2021-06-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Omeprazole Duloxetine Tizanidine Lamotrigine Gabapentin Propranolol Clonazepam Fluoxetine Topiramate
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received her vaccine at noon on 6/28/21. When she woke up in the morning on 6/29/21 she stated that her body had broken out in hives. The hives were noticed from the neck down to the pelvis. She said that the rash was not on the legs or arms and it was localized to the trunk of the body. She did not report trouble breathing and stated that the rash was just itchy.


VAERS ID: 1433948 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202821A / 1 UN / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Dizziness, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre 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: NONE
Preexisting Conditions: NONE
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: DIZZY,WEAK AND DIAPHORETIC FOR 1 MINUTE, OBSERVED FOR ADDITIONAL 30 MINUTES, INITIAL BP 102/62 AFTER 30 MINUTES 118/72, STATES SHE FELT BETTER AND WAS ACCOMPANIED HOME AFTER ADDITIONAL 30 MINUTES OF OBSERVATION


VAERS ID: 1433961 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

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

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

Write-up: Patient felt dizzy after 10 minutes of vaccine administration, patient taken to examination room and remains in supine position, checked BP -101/62, HR-52, RR-18, O2 saturation - 98%, skin looked pale and diaphoretic but never had any loss consciousness. Was talking the whole time, reports some nausea , but denies any sob, chest tightness or wheezing. No rashes. Watched the patient for next 30 minutes and patient left home after all the symptoms completely resolved


VAERS ID: 1433968 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Feeling hot, Flushing, Heart rate increased, Hyperhidrosis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Xanax
Current Illness: None
Preexisting Conditions: Anxiety
Allergies: NKA
Diagnostic Lab Data: BP 136/70 HR 85 Resp 18 SaO2 97% on Room Air
CDC Split Type:

Write-up: Pt stated feeling hot, sweaty, fast heart rate, flushed arms and chest, and weak.


VAERS ID: 1433974 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anxiety, Computerised tomogram, Dizziness, Headache, Hypoaesthesia, Nausea, Paraesthesia, Retching
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluticasone (FLONASE ALLERGY RELIEF) 50 mcg/actuation Nasl SpSn Amoxicillin 500 mg Oral Cap METOPROLOL TARTRATE ORAL Metoprolol Tartrate (LOPRESSOR) 25 mg Oral Tab norethindrone-e.estradiol-iron (JUNEL FE 1.5/30, 28,) 1.5 mg-30 mcg (21)/75
Current Illness: none
Preexisting Conditions: GOUT RIGHT BREAST LUMP HX OF PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA
Allergies: Vicodin (nausea/vomiting)
Diagnostic Lab Data: CT head
CDC Split Type:

Write-up: At 0925, pt received second Pfizer vaccine. 5 mins later, she reported to the RN that she had a mild headache, was feeling dizzy and "uneasy", reports that these symptoms started after the injection, although she was anxious prior. Denies sob or chest pain. Assisted pt to a gurney. BP 152/99, p=104, O2 sat 100% on RA. Pt reported having a hx of anxiety and paroxysmal supraventricular tachycardia. Vitals remained stable x 2, send pt to ED after 20 mins for further eval due to pt reporting that headache worsening, nausea/dry heaves and a new numbness and tingling to L side of face.


VAERS ID: 1433986 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-28
Onset:2021-06-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature increased, Chest discomfort, Eructation, Feeling abnormal, Headache, Heart rate increased, Hunger, Injection site pain
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: This morning when I woke up I had a slight headache on the back of my right side. I felt a wave within and my heart rate rose. I was really hungry and ate 3 or 4 bananas. I started to feel uneasy and felt tightness in my chest and pain below the injection site. My heart rate rose into the 100s. Normal RHR= 47-55. I was burping small burps. I was worried and started looking up ERs and contacting family. This event of immense amount tightness and uneasy feeling that lasted about 30-45. Temp was 99.4 then dropped to normal. I thought I was having a heart attack. I called my sister and my symptoms waned. I have had several "cycles" though out the day of feeling very uneasy and slight chest discomfort, but nothing on the level of this morning, or enough to make me go to the ER. It does seem that why I lay down or bend over when sitting down there is discomfort in my chest and I feel uneasy.


VAERS ID: 1433993 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-06-28
Onset:2021-06-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C2LA / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Headache, Periorbital swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Vestibular disorders (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: began having dizziness and mild swelling in skin about both eyes, mild headache, still present, but somewhat less


VAERS ID: 1433998 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Vestibular disorders (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: clindamycin, sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient felt racing heart beat and faint. patient sat down and received water. breathed deeply after 5 minutes felt better patient remainded for 15 minute recomended time and felt fine before departing


VAERS ID: 1434008 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Feeling abnormal, Hyperventilation, Malaise, Tremor
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: Per Pt''s reports HX OF ANXIETY ATTACKS
Preexisting Conditions: Per Pt''s reports ANXIETY
Allergies: NOT KNOWN ALLERGIES TO MEDICATIONS, FOOD OR ENVIRONMENT PER PT''S REPORTS
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Pt is a 36 y/o Caucasian Male who came for Covid-19 vaccine At 0845am_ I called him in to the room and during the questions about allergies and reactions to medications: So, he expressed to me that he suffered from Anxiety and panic attacks sometimes and that he had not gotten vaccines since childhood. He also verbalized apprehension about the severe side effects of this vaccines. I talked to him for a while, reassured him that the vaccination process was painless. At around 0900am I gave him the Vaccine and Kept him sitting in my room after to closely observe him. I reviewed the possible severe and mild side effects before and after Vaccine. He verbalized understanding. At 0910_ I asked him how he was feeling, and he stated that? he didn?t feel well, that he felt weird and shaky.? I called for help and nurse came in talk to Pt for a couple minutes then I asked her to call RN. They both came in the room where Pt was sitting and after talking to him for a few minutes and trying to calm him down the RN notified the Provider NP @0915_NP came in the room to assess the Pt and told us to call 911. @0920_ nurse called 911 and gave reports of Pt condition, while we transferred Pt on to exam bed and plugged Vital-Sign machine. Pt continue to hyperventilate and check his own pulse in his Carotid area. B/P 138/85; Pulse 88; RR 22; PO2 100%. @925_ the Paramedics arrived and after giving them report they assessed Pt and tried to coach Pt to slow down his breathing pattern and offered reassurance that his vital signs and Po2 was normal @ 100 % in Room air; And they also offered to take him to the hospital, but Pt declined He stated ?I?ll be Ok? this happens before. @940 Vital Signs at this time were- B/P 120/82; PR 80; PO2 100%; RR20. @950 Paramedics prepared to leave and help Pt to sit in waiting room chair. Pt sat in waiting area for 15 more minutes until he felt better and left to his home in stable condition.


VAERS ID: 1434033 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 UN / IM

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

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

Write-up: On 06/29/21 at 1340 a 37 year old female patient complained of feeling weak and dizzy 1 minutes after receiving JJ vaccine. Pt''s initial BP was 97/62, after 3 minutes she stated she felt better and last BP was 116/73. Pt was observed for an additional 30 minutes and then left with family.


VAERS ID: 1434039 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-06-28
Onset:2021-06-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Diarrhoea, Fatigue
SMQs:, Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

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

Write-up: Diarrhea, Chest Discomfort, Tiredness


VAERS ID: 1434040 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness postural, Feeling abnormal
SMQs:, Dementia (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: Dizziness occurred when standing after a 15 minute wait time. She sat back down and we gave her an ice pack and took blood pressure/pulse (159/98 + 66bpm) She waited about 10 more minutes and was not dizzy so she left with family. We checked back in at the end of the night and she was not feeling her best but wasn''t dizzy any more.


VAERS ID: 1434045 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Fall, Head injury, Headache, Nausea, Neck pain, Tenderness
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Arthritis (broad)

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

Write-up: Pt had a witnessed fall post vaccination. Per mother, pt complained of being dizzy and fell. Staff witnessed patient falling from standing to ground, and hit her head. Pt was awake and alert upon RN reaching at side. Pt was following commands. Pt stated she was dizzy and nauseated prior to syncopal episode. Maintaining C-spine precautions d/t posterior head and midline neck pain and tenderness. Team alert was called. To ED via stretcher with medics


VAERS ID: 1434050 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product use issue
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Bacterial UTI, Vaginal yeast infection
Preexisting Conditions: Unknown
Allergies: No Known Drug Allergy
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Vaccine given was past beyond use time. Vial was mixed at 7:50am and dose was administered at 3:40pm ~8 hours after mixing (should have been discarded at 6 hours)


VAERS ID: 1434051 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None listed
Preexisting Conditions: None listed
Allergies: None listed
Diagnostic Lab Data: Blood pressure 95/80 with pulse of 59 at time of event
CDC Split Type:

Write-up: Patient had a syncopal episode while sitting down approximately 5 minutes after the vaccine was given. The patient fell forward and hit her forehead on the floor resulting in a laceration. Patient was conscious and alert when the pharmacist was alerted to go to the waiting area. EMS was called as soon as rph was alerted. Patient sat in the floor for approximately 15 minutes then moved to a chair for another 10 minutes then left. Her husband and son were with her. Patient was told that EMS was on the way but declined medical attention.


VAERS ID: 1434055 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Condition aggravated, Dyspnoea, Endotracheal intubation, Hypopnoea, Intensive care, Loss of consciousness, Painful respiration, Paraesthesia, Seizure, Tachypnoea, Unresponsive to stimuli, X-ray
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (narrow), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: Pt was a truama admit due to MVA and found to have alcohol and benzo in system with active seizures at 6/28/21 and admitted to PICU. Patient recovered well and was transferred to the acute care floor by evening of 6/28/2021. Patient was to be discharge home on 6/29/2021, after 10 am C-spine was cleared.
Preexisting Conditions: unaware of any
Allergies: Allergic to mayonnaise
Diagnostic Lab Data: an x-ray was performed at bedside prior to PICU transport
CDC Split Type:

Write-up: Patient had shallow breathing and mentioned pain with each breath, otherwise no other symptoms. Care team was in the room providing discharge assessment. Provider and patient verbally confirmed agreement to receive vaccine despite pain. Shortly afterwards, patient complained of shortness-of-breath but maintaining SATs and tachypneic, patient complained of not being able to feel upper extremities despite pressure on fingers. Non-rebreather was placed. Patient then became unconscious, sternal rubs were provided without response. The code team was called and patient began to seize. Ativan was administered and patient was prepared for intubation. Patient was intubated on the floor and subsequently transferred to PICU (Pediatric Intensive Care Unit).


VAERS ID: 1434059 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

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

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

Write-up: RN stated that while administering a first dose Janssen COVID vaccine she noticed the vaccine dripping from the cap and not entering the client''s arm. RN stated less than half of the dose entered the client''s left arm intramuscularly. Lead RN confirmed with lead operations team to confirm the CDC guideline to administer a full dose of Janssen COVID vaccine into the opposite arm since less than half of the original dose was injected into the client. Lead RN advised by lead operations team to have RN administer another dose of Janssen into the client''s right arm and to have client stay for a 30 minute observation. At 1021 RN administered a full dose of Janssen COVID vaccine (LOT 205A21A, expiration date 08/07/2021) into client''s right arm intramuscularly. Lead RN educated client on ER precautions and side effects warranting a follow up for medical care. Client stayed for a 30 minute observation without incidence and left the vaccine site on her own accord with a steady gait.


VAERS ID: 1434060 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Diabetes mellitus, Throat tightness, Unresponsive to stimuli, Vital signs measurement
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Plavix
Current Illness: Recent stent placement on plavix
Preexisting Conditions: Heart disease, Diabetes
Allergies: Soma - hives
Diagnostic Lab Data: VITALS 2:08 BP - 120/90 HR - 78 RR - 18 O2 - 99%
CDC Split Type:

Write-up: Patient is a 66 year old male with diabetes and a recent history of stent placement on who received a dose of Johnson & Johnson COVID vaccine today (6/29/21). He also has a history of rash with soma. He was doing okay and talking to the nurse for 10 minutes post vaccine when he became unresponsive mid-sentence. After 1-2 minutes, he started to respond again, and noted that he felt his throat momentarily closed. However, sensation gradually improved. No nausea, vomiting, weakness on one side. After 20 more minutes of waiting, he reports his throat sensation has returned to normal.


VAERS ID: 1434062 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-27
Onset:2021-06-29
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001A21A / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / UNK UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Acetaminophen, Famotidine, Olanzapine, Risperidone, and Simethicone
Current Illness:
Preexisting Conditions: Overweight and GERD.
Allergies: Bees
Diagnostic Lab Data: None required.
CDC Split Type:

Write-up: No adverse event occurred. No treatments given


VAERS ID: 1434069 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 1 RA / IM
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS ABXB29BA / 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U6690AB / 2 LA / IM

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

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

Write-up: Client in clinic for school immunizations and mother consented to Pfizer/Covid vaccine. Review of patients health history reveals no current issues or complications today. Menactra and Bexsero given without incident. Pfizer vaccine mistakenly administered 0.5ml instead of recommended 0.3ml at 3:04 PM. Incident revealed to mother and patient of administration error. Patient remained for 45 minutes in clinic, no observation of adverse reactions observed or verbalized. Patient reported minor head lasting approximately 18 minutes. Patient left clinic with mother at 3:52. Mother educated concerning adverse signs and symptom to report immediately and seek medical attention. Mother verbalized understanding. Spoke with mother by phone at 5:45 PM and states patient reports headache. Reiterated to mother education concerning seeking medical attention if needed. All above information obtained with assistance of Health Department employee/interpreter.


VAERS ID: 1434075 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-06-28
Onset:2021-06-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Headache, Injection site pain, Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Influenze vaccine caused swollen lips and tongue. Age approx. 31
Other Medications: Dexilant, Famotidine, Lexipro, Zyrtec, Loratidine
Current Illness: none
Preexisting Conditions: GERD Sleep apnea
Allergies: Ciprofloxacin
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Soreness at injection site for 3 hours. Pain in upper arm/shoulder joint started a few hours after injection, and is diminishing into Day 2. Pain in various joints is very noticeable by 9:00am the day after injection. Left hip joint pain up to a 6/10 on pain scale. Also pain in right hip, knees, and right shoulder, not to exceed a 4 or 5 on pain scale. Also at 9:00am on Day 2, headache is quite noticeable and persisting through Day 2. I rarely get headaches normally.


VAERS ID: 1434078 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anal incontinence, Dizziness, Electrocardiogram, Loss of consciousness, Seizure, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Noninfectious diarrhoea (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 information provided
Current Illness: No illnesses at the time of vaccination obtained from patient
Preexisting Conditions: No chronic or long-standing health conditions obtained from patient
Allergies: No allergies indicated by the patient on the vaccine consent form
Diagnostic Lab Data: EMS arrived and performed an EKG, pulse oximetry and blood pressure evaluation for the patient. EMS advised the patient to seek an evaluation with either his primary care provider or with the hospital to identify if he is prone to seizures.
CDC Split Type:

Write-up: 15 to 30 seconds after immunization was administered, patient complained of lightheadedness, where he then lost consciousness and proceeded to have a seizure, where he was shaking uncontrollably for about 45 seconds. Upon regaining consciousness, the patient was able to recall what had occurred before the seizure, but said he did not remember what happened after the vaccine, and that he felt that he had defecated in his pants.


VAERS ID: 1434079 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Pruritus, Throat irritation, Throat tightness, Urticaria, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec, prenatal vitamin, bupropion/Wellbutrin
Current Illness: None
Preexisting Conditions: Endometriosis
Allergies: Latex, bees
Diagnostic Lab Data: Pulse ox 95% 1 hour after event
CDC Split Type:

Write-up: 16:14 - vaccine administered 16:24 - itchy throat, chest, and left arm; throat tightened 16:29 - coughing and wheezing; hives on chest, neck, L shoulder; took 1000 mg Benadryl 16:34 - epipen administered


VAERS ID: 1434083 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-10
Onset:2021-06-29
   Days after vaccination:80
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 047A21A / 1 UN / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Fatigue, Gait disturbance, Influenza like illness, Loss of personal independence in daily activities
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Patient stated that she was very week. Patient stated that she could hardly walk. Patient stated that she felt like she had the flu. She kept her self hydrated. Patient stated she gets tired easily and can not continue her everyday lifestyle.


VAERS ID: 1434096 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 rec''d 1 dose of moderna vaccine on 6/29/21- patient already rec''d J&J on 4/9/21.


VAERS ID: 1434248 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: PEANUT, ALL NUT, EGGS
Diagnostic Lab Data: BP AT 5:35 117/74 PULSE OX 99 BP AT 5:47 111/65 PULSE OX 99 BP AT 5:58 114/67 PULSE OX 99 HR 74
CDC Split Type:

Write-up: PATIENT DEVELOPED LOWER LIP SWELLING. NO OTHER SYMPTOMS DEVELOPED AND PT WAS MONITORED UNTIL HE LEFT WITH MOM AT 6 PM. PATIENT HAD BP, HR, PULSE OX CHECKED 3 TIMES AFTER SWELLING STARTED ALL WITHIN NORMAL LIMITS. MOM CONFIRMED THEY HAD AN EPIPEN AT HOME IF NEEDED. CALLED MOM AGAIN AT 7 PM NO ADDITIONAL SYMPTOMS REPORTED AT THAT TIME.


VAERS ID: 1434264 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Balance disorder
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad)

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

Write-up: administer vaccine at 4:45pm , few minutes later patient attempted to get up lost balance , went down on one knee. remained conscious the entire time . pharmacist helped patient up , placed in chair , got patient water and gatorade . patients blood pressure was taken and read 111/77 . after a few minutes patient felt better . Left pharmacy after a total of 30 minutes with a friend to make sure he got home without incidence .


VAERS ID: 1434267 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / IM

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

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

Write-up: PATIENT FAINTED AND BECAME PALE. RECOVERED WITHOUT ANY HELP IN 10 MINUTES.


VAERS ID: 1434277 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-28
Onset:2021-06-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Rash, 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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: POPPY SEEDS
Diagnostic Lab Data:
CDC Split Type:

Write-up: Father stated that patient has a rash on her leg. Rash is red in color


VAERS ID: 1434278 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 - / IM

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

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

Write-up: Gave 17 & 1/2 year old the Janssen by mistake instead of the Pfizer which is approved for the patients age group. Called CDC and they said the patient does not need another vaccine at this point and to fill out the vaers adverse event form. Patient and Grandfather were made aware of the error and were fine with it. No other adverse event followed.


VAERS ID: 1434282 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Loss of consciousness, Nausea
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), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: approximately 10 minutes after vaccine administration patient experienced nausea and dizziness, followed by losing consciousness for a few seconds. She recovered quickly. 911 was called and medics arrived to take vitals (blood pressure, blood sugar, heart rate).


VAERS ID: 1434294 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

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

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

Write-up: The patient fainted and noted pale face immediately after injection. He was positioned supine on the floor and applied cold towel on the forehead . The vitals were stable and was alert and oriented during this incident. He recovered and able to walk without a problem after 15 minutes. He was observed additional 15 minutes sitting in chair and left the clinic in stable condition.


VAERS ID: 1434296 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO181 / 2 LA / IM

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

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

Write-up: This was not an adverse reaction to Pfizer. This patient doesn''t speak English. She came here for her second Moderna Vaccine. The registrar asked the patient if she was here for her second Pfizer vaccine, she said yes. She was given a Pfizer card. The Interpreter verified her name, birth date, and that she was getting her second Pfizer vaccine. The patient was administered a Pfizer dose, then the patient gave the vaccinator her Covid Vaccine Record card showing that her first dose was Moderna. So she got one Moderna and one Pfizer.


VAERS ID: 1434501 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

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

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

Write-up: syncope lasting less than 2 minutes.


VAERS ID: 1434507 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Blood pressure increased, Chest pain, Dizziness, Immediate post-injection reaction, Palpitations
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none known
Current Illness: none
Preexisting Conditions: high cholesterol
Allergies: none known
Diagnostic Lab Data: Blood pressure at 15 minutes post vaccine 170/90
CDC Split Type:

Write-up: Patient described a racing heart/chest pain immediately following administration. She then reported dizziness and weakness that lasted at least 30 minutes. Blood pressure was elevated. She requested 911 to be called. She requested paramedics to transport her to the ER.


VAERS ID: 1434511 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / UNK LA / IM

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

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

Write-up: Attendee reported ''feel itchy everywhere'', no other signs or symptoms; 50mg Benadryl given PO; then reported: "I feel fine now" 25 minutes later.


VAERS ID: 1434512 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

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

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

Write-up: ADMINISTRATION ERROR: AGE <12


VAERS ID: 1434515 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-28
Onset:2021-06-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Cough, Fatigue, Headache, Lethargy, Musculoskeletal stiffness, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Chills, fever, pain all over, lethargy, cough, tired, headache, joint pain, stiffness


VAERS ID: 1434687 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-25
Onset:2021-06-29
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest pain, Dizziness, Fatigue, Headache, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vyvanse 40 mg daily but did not take day of AE
Current Illness: None
Preexisting Conditions: ADHD
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: She is a soccer player and runner with high exercise tolerance. Today she went to track practice. She experienced chest pain, dizziness, severe headache, nausea, and fatigue. She was not able to complete the workout. Heat was not a factor. She continues to have episodic chest pain, headache, and nausea the rest of the day.


VAERS ID: 1434690 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / UNK RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Asthenia, Fatigue
SMQs:, Guillain-Barre syndrome (broad)

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

Write-up: Patient received vaccine and returned two hour later with complaints of fatigue and weakness. Patient mother stated they went to the gym immediately after vaccination and patient began to feel these symptoms when they retuned to the car. Patient vital signs BP: 112/82, HR 75, O2 98%. Patient and mother informed of possibility of overworking after vaccination. Patient remained alert and oriented throughout care. Patient stated she ate very little before the gym. Patient was given orange juice and water and stated she felt a little better. Vital signs were repeated, BP: 116/84, HR 77, O2: 100%. Patient was instructed to try eating a meal and getting some rest. Also, if symptoms worsen to go to the hospital.


VAERS ID: 1434697 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), 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: Unkown
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: 15 seconds after given vaccine, patient lost consciousness and then woke up 3 times in a row, having maintained consciousness less that 30 seconds. Respirations were 16 and unlabored. Heart Rate 72. EMS called and responded within 5 minutes. Pt awake and alert when ambulance arrived. Pt stated that she had not eaten all day and had only drank 2 bottles of water. Heart rate 70''s, B/P 111/73, Resp 16, and FSBS 80 per EMS. Ambulance personnel waited at scene for 10 minutes and family made decision to bring the patient home.


VAERS ID: 1434701 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-01
Onset:2021-06-29
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / SYR

Administered by: Public       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain, Injection site rash
SMQs:, Extravasation events (injections, infusions and implants) (broad), 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: Ibprofren
Current Illness: Gallstones
Preexisting Conditions: Gallstones, liver hemangioma
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pain, redness, rash at injection site


VAERS ID: 1434704 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: none noted
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Syringe/Needle failure resulting in leakage of vaccine fluid prior to injections Patient received less than 0.3 ml dose


VAERS ID: 1434905 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Blood pressure increased, Dizziness
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypertension (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Only known prescription that I knew of was a daily hydrochlorothiazide
Current Illness:
Preexisting Conditions: Hypertension was the only chronic health condition that I was aware
Allergies: No known allergies- that I was aware of
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: 57 yof that presented for her first dose of the Pfizer COVID-19 vaccine. She was slightly anxious before getting the immunization. Around 1620, patient received her first dose of the vaccine in her left deltoid and within approximately 10 minutes of her immunization she started to feel like she was going to faint. 1633 staff member applied an ice pack to the back of her neck and gave her water while another used a paper to fan her. Her vitals were taken Temp 97.7 Resp 20 BP (R) 218/181 HR 84. Recheck of BP (R) 202/116. Heart Rate: RRR and LS clear. She has a history of hypertension and reports it is well controlled with a daily hydrochlorothiazide (mg unknown). She takes her medication every morning and checks her BP daily. She reports her BP is typically 120?s/80?s. 1702 Patient was feeling better and wanted to use restroom. Vitals: Temp 97.8 Resp 16, BP (R) 172/107 HR 72. 1717 She ambulated to the restroom with assistance and tolerated well. 1730 Temp 97.8, Resp 16, BP (R) 176/105 (L) 156/102 HR 67. Pt remained asymptomatic. 1748 (R) 173/105 (L) 195/107. Discussed with patient that I recommend she go to the ER for evaluation due to her near syncopal episode and her elevated blood pressure. Pt agreed to go to the ER. EMS was not called. One of her fellow staff members agreed to drive her to the hospital. 1612 Patient and staff member left at 1812.


VAERS ID: 1434909 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-28
Onset:2021-06-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Asthenia, Chills, Decreased appetite, Fatigue, Headache, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (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: Simvastatin; Lisinopril/HCTZ; Estradiol; Cymbalta; Seroquel; Vitamin: B12, D3, C
Current Illness: Prior sinus infection
Preexisting Conditions: Sinusitis, degenerative back disease, high blood pressure, high cholesterol, bi-polar, PTSD, anxiety
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Fatigue, weakness, all over body aches, loss of appetite, chills, headache, abdominal pain and nausea, started the morning after the vaccine was taken. Started on naproxen for aches; bedrest for fatigue; did not eat; sipped Gatorade. I am on the day after at this time.


VAERS ID: 1434911 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Nausea, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (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? 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: BLOOD PRESSURE 61/30, PULSE 52 AT 2:15PM
CDC Split Type:

Write-up: PATIENT FAINTED ABOUT 2 MINUTES. PATIENT WAS PALE, SWEATING, NAUSEOUS, & DIZZY. PATIENT''S BLOOD PRESSURE WAS TAKEN 2 MINUTES APART UNTIL EMT ARRIVED. PATIENT WAS ASSESSED AND EVENTUALLY WAS ABLE TO LEAVE WITH PARENT.


VAERS ID: 1434912 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-27
Onset:2021-06-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper
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: Multivitamin, Vitamin A, vitamin D, vitamin C, Magnesium, Fish Oil, Keratin, Biotin, Collagen, Protein
Current Illness: Hemorrhoids, Bartholin Cyst, Periodontitis
Preexisting Conditions: Periodontitis, Constipation
Allergies: Sensitivity to Dairy, pepper seasoning, red meats
Diagnostic Lab Data: Not applicable
CDC Split Type:

Write-up: Stomach shocks in left abdomen started about 34 hours after 2nd vaccine. I contacted my gastroenterologist about going to ER. He recommended MiraLax. Found out about 2 other people that experienced same symptoms after their 1st or 2nd vaccination. I forgot to tell the gastroenterologist about vaccination. People recommended Pepto Bismol and/or Tylenol. Pharmacists confirmed Tylenol and Pepto Bismol ok after MiraLax. Said I could take both. I took Pepto Bismol and it got worse. I figured because empty stomach and did chicken broth which helped a lot. I also placed heating pad on my stomach. I felt a stomach shock as I''m typing this.


VAERS ID: 1434916 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 1 LA / IM

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

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

Write-up: faint


VAERS ID: 1435064 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 2 LA / SYR

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

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

Write-up: HIGH FEVER 104.5 CHILLS ACHES


VAERS ID: 1435068 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-28
Onset:2021-06-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Cold sweat, Dyspnoea, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Chostracondritis
Allergies: Seafood, paxil, nuts
Diagnostic Lab Data: Cant afford to go to a doctor. No insurance.
CDC Split Type:

Write-up: Severe pain in left arm and chest. Labored breathing. Cold sweats.


VAERS ID: 1435076 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dyspnoea, Feeling abnormal, Headache, Injection site pain, Suffocation feeling, Tremor, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Dementia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), 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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received vaccine together with his family (he was 3rd out of 4). He said the shot hurt. After all were vaccinated, he said he felt weird. I had him sit for monitoring with his family. His parent told me he still felt weird, and that they walked around the store, but now he has a bad headache and feels a little winded. I had him sit in the immunization room with mask off for further monitoring. After a few more minutes, he said it felt like he was suffocating. I administered 1 Epi-Pen at 10:08PM in his left thigh and called an ambulance. Soon after, he was shaking/shivering, but said it was getting easier to breathe. EMT arrived shortly after, noted the hives on his back, and took him to the hospital.


VAERS ID: 1435081 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-06-28
Onset:2021-06-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Menstruation irregular, Migraine, Pain, Pain in extremity, Thirst
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Fertility disorders (broad), Tendinopathies and ligament disorders (broad), Dehydration (broad)

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

Write-up: Irregular menstrual bleeding (bleeding started again, last day of last period was 1.5 weeks ago). Extreme fatigue. Severe pain (6 out 10 pain scale) in right arm. Headache/migraine that has lasted 2 days. Body aches. Chills. Thirst.


VAERS ID: 1435094 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Cardiac failure acute, Cardiomyopathy, Dyspnoea, Echocardiogram, Ejection fraction decreased, Exercise tolerance decreased, Fatigue, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Please contact hospital for H&P dated 6/29/21
Current Illness: None
Preexisting Conditions: Please contact hospital for H&P dated 6/29/21
Allergies: Amoxicillin, medical tape
Diagnostic Lab Data: Echo: EF 22% from prior of 55%
CDC Split Type:

Write-up: Possible myocarditis. Patient experiencing profound non-ischemic cardiomyopathy and acute CHF, without obvious other cause on preliminary investigation. Sx of fatigue, dyspnea, exercise intolerance, myalgia began 24 hours after vaccination. Myalgias resolved but CHF progressed until Dx 6/29/21. Previously an active runner.


VAERS ID: 1435102 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-06-28
Onset:2021-06-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

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

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

Write-up: Large itchy, tender, swollen and hard red area surrounding injection site. No treatment except icing


VAERS ID: 1435478 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-28
Onset:2021-06-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Chills, Fatigue, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Chest pain; fever; chills; fatigue.


VAERS ID: 1435975 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-28
Onset:2021-06-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

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

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

Write-up: Rash in some areas of the body, itching.


VAERS ID: 1436991 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A214 / 1 RA / IM

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

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

Write-up: Error: Patient Too Young for Vaccine Administered-


VAERS ID: 1437027 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 2 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: 1437028 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dizziness, Flushing, Hyperhidrosis, Hypotension, Syncope, Tremor, Visual impairment
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Medium, Systemic: Hypotension-Medium, Systemic: Shakiness-Medium, Systemic: Visual Changes/Disturbances-Severe, Systemic: Weakness-Medium


VAERS ID: 1437030 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

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

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

Write-up: Systemic: Fainting / Unresponsive-Mild, Systemic: Seizure-Mild, Additional Details: Patient informed pharmacist of vasovagal history of passing out from vaccines. Patient passed out 3 minutes after administration and was layed to floor by pharmacist and her close friend. Patient possibly started to a 15 second tonic-clonic seizure from the vaccine. Previous history of seizures.


VAERS ID: 1437031 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Eye movement disorder, Headache, Nervousness, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Headache-Mild, Additional Details: Mom stated pt felt lightheaded, her eyes rolled back, and fainted for a few seconds. When we observed her, pt was ok but a little shaky. The paramedics came and checked on her, but mother declined going to ER


VAERS ID: 1437035 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

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

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

Write-up: Systemic: Confusion-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Exhaustion / Lethargy-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Shakiness-Medium, Additional Details: Patient passed out about 5 minutes after receiving the covid vaccine, he was sweaty, and recovered after a few minutes, we gave water and crackers


VAERS ID: 1437039 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Eye contusion, Face injury, Fall, Syncope, Tooth fracture
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (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? 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-Severe, Systemic: Fainting / Unresponsive-Medium, Additional Details: Patient received covid vaccine, approximately 10 minutes after patient slumped foward in chair then fell out of the chair and struck there face on an unkown object, blacked eye and chipped patients tooth. I went to the pharmacist rushed to patient''s side made sure they were awake, asked technician to call 911, assisted patient back in the chair. Had technician stay with patient got him a water and waited for paramedics to arrive. The paramedics determined patient could leave.


VAERS ID: 1437040 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 2 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Nausea-Mild


VAERS ID: 1437042 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fatigue, Flushing, Hyperhidrosis, Injection site pain, Lethargy, Nausea, Syncope, Unresponsive to stimuli, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (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), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Site: Pain at Injection Site-Mild, Systemic: Dizziness / Lightheadness-Medium, Systemic: Exhaustion / Lethargy-Medium, Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Severe, Systemic: Nausea-Severe, Systemic: Vomiting-Severe, Additional Details: Patient reported severe dizziness and nausea about 5 minutes after receiving the Pfizer vaccine. She ended up vomiting few times. Patient was given water and crackers. She did not end up feeling better even after resting for 15 minutes. The family called 911 and Emergency services took her to the hospital


VAERS ID: 1437045 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: North Dakota  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY0584 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaphylactic reaction, Confusional state, Dizziness, Dysphagia, Dyspnoea, Fatigue, Flushing, Hyperhidrosis, Injection site bruising, Injection site erythema, Injection site pain, Injection site pruritus, Injection site swelling, Lethargy, Syncope, Throat tightness
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Arrhythmia related investigations, signs and symptoms (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: Site: Bruising at Injection Site-Mild, Site: Itching at Injection Site-Mild, Site: Pain at Injection Site-Mild, Site: Redness at Injection Site-Mild, Site: Swelling at Injection Site-Mild, Systemic: Allergic: Anaphylaxis-Severe, Systemic: Allergic: Difficulty Breathing-Severe, Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Severe, Systemic: Confusion-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Exhaustion / Lethargy-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Severe.


VAERS ID: 1437046 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 RA / IM

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

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

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


VAERS ID: 1437048 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Flushing, Hyperhidrosis, Hypoaesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (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: Chills-Mild, Systemic: Flushed / Sweating-Mild, Systemic: Numbness (specify: facial area, extremities)-Mild


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