National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 7/16/2021 release of VAERS data:

Found 479,813 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 79 out of 4,799

Result pages: prev   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178   next


VAERS ID: 1414107 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-05-21
Onset:2021-06-21
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Dizziness, Dyspnoea, Electrocardiogram, Fatigue, Insomnia, Migraine, Pain, Pain in extremity, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Propanolol 5 mg 3 x day Potassium 20 MEQ - 2 tablets 3 x day Eplereone 25 mg 1 x day Testosterone 10 mg 1 x day Armour Thyroid 30 mg 1 x day Vitamin D3 1 x day Biotin 5,000 mg 1 x day
Current Illness: Postural Orthostatic Tachycardia Syndrome Hypokalemia Hyperaldosteronism
Preexisting Conditions: Postural Orthostatic Tachycardia Syndrome Hypokalemia Hyperaldosteronism
Allergies: Epinephrine Doxycycline Metrodonazole
Diagnostic Lab Data: 1. Called General Practioner Doctor about symptoms , they said what I have are rare side effects, but to proceed with 2nd shot. Doctor''s nurse did not suggest an in office examination. Said to proceed with 2nd dose as scheduled for June 11. I did not proceed with 2nd dose due to ongoing side effects and concerns. Cardiology follow-up appointment 2. Cardiology appointment and EKG June 17, 2021 3. Call/email with request for further evaluation due to ongoing symptoms June 21, 2021
CDC Split Type:

Write-up: 9 hours after receiving my first dose I had severe chest pains. tremors, insomnia, migraine headaches. The symptoms lessened after the first 3 days but still come back randomly and are now becoming constant again- constant chest pains, dizziness, shortness of breath and fatigue. Pain is radiating down my left arm and legs as well. I have notified my cardiologist and will be requesting further evaluation of side effects.


VAERS ID: 1414262 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 1 LA / IM

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

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

Write-up: The patient is 14 years old and Moderna vaccine was given by mistake. No adverse event! The patient is doing fine so far.


VAERS ID: 1414307 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / N/A RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood ethanol, Computerised tomogram head, Drug screen, Full blood count, Metabolic function test, Nausea, Seizure, Seizure like phenomena, Troponin, Vomiting
SMQs:, Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Drug abuse and dependence (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: influenza: rash, shortness of breath, Tdap: rash, shortness of breath
Other Medications: Advair, aleve, androgel, benadryl, claritin, epipen, flonase, fluoxetine, hydroxyzine, multivitamin, singulair, ventolin
Current Illness: None
Preexisting Conditions: Female to male transition, asthma
Allergies: eggs, nuts, penicillins, ceclor, ibuprofen
Diagnostic Lab Data: CMP, CBC, EtOH, UDS, troponin, CT head
CDC Split Type:

Write-up: Patient started to experience nausea/vomiting soon after getting the vaccine, then started convulsing and having seizure-like symptoms.


VAERS ID: 1414345 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-07
Onset:2021-06-21
   Days after vaccination:75
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

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

Write-up: pain 7/10


VAERS ID: 1414400 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-19
Onset:2021-06-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA EW0164 / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Nausea, Pharyngeal swelling, Throat irritation
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol, atarax
Current Illness: none
Preexisting Conditions: none
Allergies: neomycin, medrol dose pack,hazel nut, soy, treenuts, latex,
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Swelling in throat mild, itchy, and a little nausea, lasted until she took Benadryl.


VAERS ID: 1414440 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-11
Onset:2021-06-21
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732EXP:07/31 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Angina pectoris, Dizziness, Palpitations, Presyncope
SMQs:, Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Other ischaemic heart disease (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Telmisartan and Hydrochiorothiazide Tablets 80 mg/25mg for blood pressure
Current Illness: none
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: lightheaded, heart palpitations, heart tightening, near passing out


VAERS ID: 1414488 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-06-04
Onset:2021-06-21
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 1 RA / IM

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

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

Write-up: Patient was inadvertently administered the Moderna Vaccine Patient is only 16. Patients fathered signed the consent


VAERS ID: 1414525 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 2 LA / IM

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

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

Write-up: Pt vaccinated at 10:36 am, at approximately 10:54am, pt states she is having "chest pain and pressure, 4 on 1-10 scale" refused EMS evaluation. VS assessed 97% o2, Hr 88, BP 137/99, R 18, T 97.1. States pain has been on and off since one day post first vaccine dose and has not been evaluated by MD. Dr. made aware at 11am. VS reassessed 113/56, P 76, R 18, o2 99%. "pain subsided" advised to seek medical attention should pain return, AMA executed due to refusing further medical evaluation. Left in no acute distress accompanied by driver and 2 other passengers,


VAERS ID: 1414532 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Catheterisation cardiac normal, Chest pain, Dyspnoea, Echocardiogram normal, Troponin increased
SMQs:, Anaphylactic reaction (broad), Myocardial infarction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: untreated hypertension, Anxiety
Allergies: None
Diagnostic Lab Data: Troponin levels increased serially. ECHO normal, Heart Cath normal
CDC Split Type:

Write-up: Pt age 19, male, four days after his second dose of Pfizer vaccine had chest pain, shortness of breath,. He was admitted for two days to the hospital and had a work up. He improved with no official diagnosis and was released.


VAERS ID: 1414535 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (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: 0920 Throat tightness. Hx of allergies. BP 151/87, HR 66, Resp 17 unlabored, Sats 98%. Refused epi injection reports he has epi pin at home. Stated "it''s not that bad". 0930 left ambulating for home accompanied by his son. Stating "if it was going to be bad it would have gotten worse by now". Educated on S/S to seek immediate care for. He verbalized understanding


VAERS ID: 1414542 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 2 LA / IM

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

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

Write-up: Pt vaccinated at 10:36 am, at approximately 10:54am, pt states she is having "chest pain and pressure, 4 on 1-10 scale" refused EMS evaluation. VS assessed 97% o2, Hr 88, BP 137/99, R 18, T 97.1. States pain has been on and off since one day post first vaccine dose and has not been evaluated by MD. Dr. made aware at 11am. VS reassessed 113/56, P 76, R 18, o2 99%. "pain subsided" advised to seek medical attention should pain return, AMA executed due to refusing further medical evaluation. Left in no acute distress accompanied by driver and 2 other passengers,


VAERS ID: 1414585 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Iodine, Previous similar reaction to unknown muscle relaxer
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt reported feeling very cold, UE cold to palpation and observed UE & LE shaking. AOx3 and able to follow directions and answer questions. Reports similar allergic reaction to unknown muscle relaxer in the past. Reports sypmtoms did not occur with 1st Pfizer dose. Benadryl 50mg PO administered w/ water at 1225. VSS. Pt reports feeling "much better" shortly after, intermittent shaking continues. Requested to use restroom at approx 1240. Escorted to restroom with family after obtaining stable orthostatic VS and pt reported no dizziness. VS 1220 sitting HR 125, RR 25, BP 145/86, O2 99%RA 1228 sitting HR 71, RR 18, BP 115/66, O2 99%RA 1240 sitting HR 104, RR 18, BP 125/75, O2 98%RA 1242 standing HR 103, RR 18, BP 122/75, O2 98%RA Released w/ family @ 1250


VAERS ID: 1414591 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Pallor
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (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 reported
Diagnostic Lab Data: na
CDC Split Type:

Write-up: After 15 minute wait period, pt left with mother. When they got outside, pt started feeling lightheaded. Pt''s mother brought pt back to clinic, PCT escorted them to exam room and had pt lay on exam table. When NP arrived in exam room, pt was alert, face pale. NP placed cool wet washcloths on forehead and neck. After a couple minutes, color started to come back to face, had her continue to stay lying down for another few minutes. Had pt sit up on exam table for 5 minutes. Mother bought her orange juice, which she drank a little while in clinic. Had pt stand in exam room for 2 minutes. Then they moved to waiting area for another 15 minutes. Checked back with patient and she was feeling ok. Pt left with mother without difficulty. Pt has not had this reaction with any other vaccines. Has passed out at school at sight of blood.


VAERS ID: 1414611 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-10
Onset:2021-06-21
   Days after vaccination:72
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Eye pain, Fatigue, Headache, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Glaucoma (broad), Lens disorders (broad), Retinal 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: calcium+vitamin D Estradiol Valerate Tylenol
Current Illness: none reported by patient
Preexisting Conditions: GAD
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had her Janssen vaccine on 04/10/2021. She is currently c/o blurred vision, headaches with left eye pain, and thoracic back pain since she received her vaccine. She reports the headaches and back pain as a 10/10 on the numeric pain scale despite taking OTC medications. She says she attempted to come in as a same-day walk-in last week but the wait was too long and she left home. She denies any nausea or vomiting but says that these are the worst headaches of her life and that she never had these headaches prior to the vaccine. She is also c/o extreme fatigue. She denies any fevers, CP, or SOB


VAERS ID: 1414674 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-11
Onset:2021-06-21
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Carbon dioxide decreased, Diabetic ketoacidosis, Glycosylated haemoglobin increased, Lethargy, Pollakiuria, Sluggishness
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol and loratadine
Current Illness: None
Preexisting Conditions: intermittent asthma
Allergies: NKA
Diagnostic Lab Data: CO2<10 A1C 13.4
CDC Split Type:

Write-up: Diabetic ketoacidosis CO2<10 A1C 13.4 Weak/sluggish/lethargic,/urinating a lot


VAERS ID: 1414679 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Oropharyngeal pain, Pyrexia, Respiratory tract congestion
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: lamictal, claritin, hydroxicine, tylenol,
Current Illness: none
Preexisting Conditions: epilepsy, asthma, autsim
Allergies: latex, cold, seasonal
Diagnostic Lab Data:
CDC Split Type:

Write-up: fever, sore throat, cough, congestion


VAERS ID: 1414680 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-19
Onset:2021-06-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (narrow)

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

Write-up: increased blood pressure. had a systolic reading of 191 at home, came to pharmacy to check, had a systolic reading of 244


VAERS ID: 1414944 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-20
Onset:2021-06-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6870 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event, Product preparation issue
SMQs:, Medication errors (broad)

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

Write-up: pt received 0.3 ml of undiluted pfizer vaccine so 3.3 times normal dose, patient is currently feeling ok with no side effects 28 hours after administration


VAERS ID: 1414956 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820096 / 1 LA / IM

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

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

Write-up: Patient experienced syncope and sweating a few minutes after vaccination. He recovered immediately and experienced no further symptoms for the remainder of the observation period.


VAERS ID: 1414962 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aphasia, Feeling cold, Feeling hot, Hyperhidrosis, Malaise
SMQs:, Neuroleptic malignant syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (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: None
CDC Split Type:

Write-up: Patient was screened for COVID-19 Vaccine administration. Patient had no contraindications and was administered Moderna Vaccine at 10:12 am. At approximately 10:20 am patient stated he was not feeling well. Patient stated he was feeling cold. Patient was not having shortness of breath or difficulty breathing. He was sweaty and seemed to have a bit of difficulty talking. After monitoring for a few minutes, patient stated he was feeling worse and wanted emergency services. Technician called 911 and emergency services arrived within a few minutes. Prior to emergency services arriving, patient expressed he was feeling hot. As emergency services arrived, patient stated he was feeling better. Emergency services assessed patient, and patient refused to go to hospital. Both patient and fire department left pharmacy at 10:42 am.


VAERS ID: 1414964 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-03
Onset:2021-06-21
   Days after vaccination:79
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen, albuterol, Combivent, allopurinol, atorvastatin, benzonatate, OS-CAL + D, carvedilol, cetirizine, Premarin vaginal cream, diclofenac, famotidine, Flonase, folic acid, furosemide, gabapentin, guaifenesin, levothyroxine, mycop
Current Illness: N/A
Preexisting Conditions: Rheumatoid arthritis, CHF, chronic back pain, COPD, disc disorder, osteopenia
Allergies: Amlodipine
Diagnostic Lab Data: Positive SARS-CoV-2 PCR 6/21/2021
CDC Split Type:

Write-up: Patient admitted to the hospital with COVID-19 2 months subsequent to full vaccination


VAERS ID: 1414995 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Pharyngeal swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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: depo-provera
Current Illness: none
Preexisting Conditions: none
Allergies: allergic to aspirin and latex
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient felt her throat closing and had trouble breathing.


VAERS ID: 1415047 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 3 LA / IM

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

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

Write-up: patient got 3 doses of the moderna covid vaccine. on 5/22/21, on 6/19/21, and today on 6/22/21. He showed up today with a vaccine card that only had one dose listed on it so we gave him what we thought was his second shot. he then called back three hours later to tell us he got his second shot on 6/19 he just didn''t have his card with him so it never got put on the card, and todays dose was dose number 3. he has no side effects as of now, and we told him to go to the er if he starts feeling bad.


VAERS ID: 1415068 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Lip swelling, Rash, Throat tightness, 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? 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: Vaccine received at 0914, reaction occurred at 1008. Difficulty breathing, swelling to upper and lower lips, throat tightening, audible wheezing, rash to neck and chest. Two doses of Epinephrine and Benadryl given, oxygen administered, EMS called and taking to hospital via EMS at 1027.


VAERS ID: 1415100 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cough
SMQs:, Anaphylactic reaction (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: sickle cell anemia
Allergies: Mold, Grass, Codeine, Ibuprofen, Morphine, Sulfur
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Post vaccine admin in 30 min obs pt started coughing and feeling like she was having an allergy. Pt was sent to Med Obs. VS obtained. Pt was given water and crackers since pt haven''t eaten. pt didn''t have her inhaler. PO Benadryl was offered but pt only takes at night. Pt was released and she has a b/p cuff at home to check it and follow up on her b/p. 1414 SITTING BP 170/83 HR 65 RR 18 SpO2 98% 1420 SITTING BP 156/92 HR 72 RR 20 SpO2 99% 1432 SITTING BP 155/90 HR 71 RR 18 SpO2 97%


VAERS ID: 1415138 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-06-14
Onset:2021-06-21
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event
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: INFO WAS NOT PROVIDED
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE GIVEN
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: NO ADVERSE REACTION REPORT BY PARENT (MOM)-


VAERS ID: 1415147 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Wyoming  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Accidental exposure to product, Product preparation error, Product reconstitution quality issue
SMQs:, Medication errors (narrow)

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

Write-up: PFIZER Covid-19 vaccine LOT# EW0151 EXP. 07/2021 was reconstituted with 1.8ml of JANSSEN Covid-19 vaccine LOT#043A21A EXP. 06/21/2021 instead of the Sodium Chloride 0.9% (18mg per 2ml) diluent provided for reconstitution. Individual was given 0.3ml IM left deltoid of incorrectly reconstituted vaccine.


VAERS ID: 1415159 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 2 LA / IM

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

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

Write-up: Patient was dizzy and weak after the vaccine was administered. After 10 minutes later she passed out. EMS came to take care of her. All the tests were normal. Her glucose level was low. She was given glucose oral gel to take before she left with her dad.


VAERS ID: 1415165 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821287 / N/A LA / IM

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

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

Write-up: Patient did not have an adverse event. the patient was supposed to be given the 2nd dose of Pfizer but was accidentally given the Janssen vaccine instead. patient had no adverse reactions and pfizer stated that the cdc states janssen can be given to those that do not tolerate the 1st dose of pfizer so medical issues do not seem to be a concern. also j&j stated they are going to approve this vaccine being to individuals less than 18 years old and they do not see a safety issue with this event


VAERS ID: 1415179 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Amnesia, Blood glucose, Dizziness, Electrocardiogram, Head injury, Joint contracture, Loss of consciousness, Miosis, Syncope, Tachypnoea, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Arthritis (broad), Respiratory failure (broad), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient denies taking any medications, dietary supplements, or herbal remedies at time of vaccination.
Current Illness: Patient denies any illness recently
Preexisting Conditions: Patient denies any past medical history.
Allergies: Denies any allergies to medications, food or other products.
Diagnostic Lab Data: NA. No medical lab tests related to adverse event.
CDC Split Type:

Write-up: Pt w/o medical hx/drug allergies presents with syncope in observation area s/p J&J injection. Patient stood up with dizziness and loss consciousness with head injury on counter. (Estimated 10 Seconds KO). Upon arousal pt presents tachypnea, pin-point pupils, hand contractions, one episode of vomiting, loss of memory. Orientated to name/dob although does not know location or recollection of receiving vaccine. EMS called responding to seen. Initial VS: BP: 86/55, O2: 96%, HR 81. Paramedics responding on scene EKG/BS checked patient taken to . Pt stabilized and transported with AMR paramedics to .


VAERS ID: 1415182 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

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

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

Write-up: pt received moderna instead of pfizer


VAERS ID: 1415197 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Product preparation 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: reports not sick today
Preexisting Conditions: unknown
Allergies: none listed
Diagnostic Lab Data:
CDC Split Type:

Write-up: PFIZER Covid-19 vaccine LOT# EW0151 EXP. 07/2021 was reconstituted with 1.8ml of JANSSEN Covid-19 vaccine LOT#043A21A EXP. 06/21/2021 instead of the Sodium Chloride 0.9% (18mg per 2ml) diluent provided for reconstitution. Individual was given 0.3ml IM left deltoid of incorrectly reconstituted vaccine.


VAERS ID: 1415199 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Patient had what it seems like seizure after getting her vaccine which lasted about 30 seconds, EMS was called. Patient was transferred to Hospital


VAERS ID: 1415202 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA )21C21A / 1 RA / IM

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

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

Write-up: 14 year old received Moderna Covid 19 vaccine in administration error for off label use. There are no side effects known at this time.


VAERS ID: 1415207 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA )21C21A / 1 RA / IM

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

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

Write-up: 14 year old received Moderna Covid 19 vaccine in administration error for off label use. There are no side effects known at this time.


VAERS ID: 1415220 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered, 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: Vyvanse, Clonidine
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: A previously diluted, used, and since expired vial of Pfizer Covid vaccine was rediluted and a dose of 0.3ml was administered. Pfizer was contacted for inappropriate administration guidance. The patient''s father was contacted and the situation explained. At this time, the patient is not redoing this dose and will wait to receive the 2nd dose at the appropriate time. The patient''s father was advised to monitor for adverse reactions including infection at the injection site.


VAERS ID: 1415221 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-05
Onset:2021-06-21
   Days after vaccination:167
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Dyspnoea, Pneumonia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: HEART FAILURE AND LUNG PROBLEMS
Preexisting Conditions: HEART FAILURE AND LUNG PROBLEMS
Allergies:
Diagnostic Lab Data: 6/21/21-COVID-19 TEST AND CHEST X-RAY
CDC Split Type:

Write-up: DIAGNOSED AND HOSPITALIZED WITH COVID-19 AND PNEUMONIA ON 6/21/21 AFTER BEING VACCINATED WITH MODERNA VACCINE IN JAN/FEB. SHE HAS HAD INCREASING SHORTNESS OF BREATH FOR SEVERAL DAYS AND SAW HER PCP TODAY. SHE IS ON STEROID MEDS AND NEB TREATMENTS FREQUENTLY.


VAERS ID: 1415224 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Disorientation, Fall, Fatigue, Loss of consciousness, Seizure
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), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: A few minutes after pt received vaccine pt fell down was unconscious and started seizing for approx. 15 to 20 seconds. He remained uncounsious for an additional 30 seconds and woke up 30 seconds later. He awoke very disoriented and tired. He remained lying down until ems was able to come. He was then taken to the ER.


VAERS ID: 1415228 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Wyoming  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: No adverse event
SMQs:

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

Write-up: unknown


VAERS ID: 1415245 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Wyoming  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Accidental exposure to product, Product preparation error, Product reconstitution quality issue
SMQs:, Medication errors (narrow)

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

Write-up: PFIZER Covid-19 vaccine LOT# EW0151 EXP. 07/2021 was reconstituted with 1.8ml of JANSSEN Covid-19 vaccine LOT#043A21A EXP. 06/21/2021 instead of the Sodium Chloride 0.9% (18mg per 2ml) diluent provided for reconstitution. Individual was given 0.3ml IM left deltoid of incorrectly reconstituted vaccine.


VAERS ID: 1415254 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered, Product preparation issue, Underdose
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: Advair; Albuterol; Bupropion XL
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: A previously diluted, used, and since expired vial of Pfizer Covid vaccine was rediluted and a dose of 0.3ml was administered. Pfizer was contacted for inappropriate administration guidance. A voicemail was left for the patient asking for a return phone call. At this time, it is not recommended to have the patient repeat the 2nd dose. If the patient returns our call, she will be advised to monitor for adverse reactions including infection at the injection site.


VAERS ID: 1415303 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Dizziness, Head injury, Hyperhidrosis, Nausea, Paraesthesia, Seizure, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient denied taking anything to pharmacy and paramedics.
Current Illness: Patient had diverticulitis. Patient said last September, he had a seizure thought to be due to the combination of medications he was taking at the time.
Preexisting Conditions: Patient denies any chronic or long-standing health conditions.
Allergies: patient reported no allergies to pharmacy or paramedics.
Diagnostic Lab Data: None performed in pharmacy. Patient taken to ER.
CDC Split Type:

Write-up: Patient was in the lobby area of pharmacy when he passed out. The pharmacy manager tried to talk to the patient, but he appeared to be having a seizure (his eyes were rolled up in his head, he was shaking). When the patient came to he seemed confused about where he was. He began sweating profusely. He said he was nauseated and lightheaded. He said he was tingling all over his body. We also noticed that he was bleeding where he hit his head on the ground when he passed out. He stayed seated while the pharmacy manager held a paper towel to the bleeding part on his head. He sipped some water until the EMS arrived and took over. The patient left to go to the ER with the EMS crew after 3:00PM.


VAERS ID: 1415309 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Cold sweat, Dizziness, Feeling cold, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: She complained of having dizziness, fainting and chest pain just 5 minutes after the covid-19 shot was administered to her. Her blood pressure was 147/107 and pulse was 68. She said is feeling cold, clammy and her chest is squeezing her, I gave her a shot of Epinephrine and the emergency first responder came to take over.


VAERS ID: 1415312 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, 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), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: PATIENT APPEARED LIGHTHEADED THEN SEEMED TO PASS OUT FOR 8 TO 10 SECONDS WITHIN 2 TO 3 MINUTES OF THE VACCINE BEING ADMINISTERED. HE CAME TO AND WAS ABLE TO SPEAK TO THE EMS STAFF WHEN THEY ARRIVED. PATIENT WAS TAKEN TO ER FOR EVALUATION.


VAERS ID: 1415322 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-21
Onset:2021-06-21
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821287 / 1 LA / IM

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

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

Write-up: Patient vomited approximately 10 minutes post vaccination


VAERS ID: 1415325 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: When making the appointment for patient in question I spoke with a translator who confirmed with me the children that she was making an appointment for were 12 or older. Before I administered vaccine I asked the patient for her DOB but she was so nervous about the vaccine that she only gave me the month and the day but couldn''t remember the year. Since I had previously confirmed with the translator that the child was at least 12 (who was unable to make it to the appointment) I went ahead and administered the vaccine. After I administered the vaccine the child told me that her birthday was not as reported.


VAERS ID: 1415327 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Loss of consciousness, Syncope
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), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Coreg, Lisinopril, Atorvastatin are patient''s maintenance medications.
Current Illness:
Preexisting Conditions: HBP, High Cholesterol, DM II
Allergies: Codeine reported on PQCF
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient experienced syncope while he was sitting for his 15 minute post vaccination wait time. Staff member had conversation with patient in vaccine booth and patient mentioned syncope often happens at the MD office when he gives blood/has blood drawn- usually does not occur following vaccinations. Staff member noticed patient was starting to nod off while sitting upright in chair. she went to check on him to see if he felt okay and patient starting falling out of chair and was unconscious with his eyes open. Staff member was able to catch patient from hitting head on the ground. checked blood pressure and heart rate frequently and helped cool patient off due to excessive sweating. patient had readings 58/44 55 bpm, 126/80 83 bpm, 145/93 89 bpm, and 152/95 91 bpm. patient reports last reading is more like his normal readings. patient experienced 2 dizzy spells so he lied down on the ground, flat on his back with his feet propped. patient''s father was waiting in parking lot and patient was able to call father priorto event occurring. according to patient and his father, patient''s mother experiences same when she has blood drawn and at every MD appointment, he will immediately lay down prior to having blood drawn. 911 was called and EMTs arrived. patient was back to normal and feeling fine. he was able to stand up on own. patient left with father. will call patient before leaving today to check and make sure he is okay.


VAERS ID: 1415333 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / UNK LA / IM

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

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

Write-up: Pt c/o feeling light-headed... stated that he didn''t eat breakfast today. Pt admin OJ & monitored for an additional 15 mins. BP-130/70, P-86, R-24, O2 Sat-96, @ 11:35a... Pt feeling better, advised to call PCP is anything changes. Pt left in stable condition. BP-128/70, P-78, R-16, O2 Sat 98, @ 1150a...


VAERS ID: 1415334 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 2 LA / IM

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

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

Write-up: patient felt lightheaded then fainted for a few seconds. ice packs used and drank water, came back to consciousness.


VAERS ID: 1415342 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Feeling hot, Pain in extremity, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: PATIENT RETURNED TO PHARMACY APPROX 3 HOURS AFTER RECEIVING 2ND DOSE OF MODERNA VACCINE. ( SHE IS AN ASSOCITAE WITHIN OUR STORE) AND COMPLAINED OF ITCH AND ARM SORENESS, NO SWELLING OF LIPS OR TONGUE UPON EXAMINING HER, SHE STATED SHE FELT A BIT ANXIOUS AND WARM , I RECOMMENDED TRYING AN ANTIHISTAMINE FOR ITCH , EXPALINED TO HER THAT MAYBE SHE SHOULD SHOULD CONTACT STORE MANAGER AND POSSIBLY LEAVE FOR DAY. ASSISATANT MANAGER WAS NOTIFIED AND DISCUSSED OPTIONS.


VAERS ID: 1415344 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0161 / 1 LA / IM

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

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

Write-up: The patient has a history of fainting after shots. She became warm and faint after receiving the injection. She was very weak and put her head on the table for about 10-15 minutes until she was feeling better.


VAERS ID: 1415358 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Fainting, all past vaccinations
Other Medications: Clindamycin lotion, tretinoin cream
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reported history of fainting before/after vaccination in the past. Reported Phobia of needles. Patient was fine after vaccination and was let into the lobby to wait 15 minutes for observation. After about 10 minutes, patient had fainted. Patient was in chair and supported to not fall out of the chair. Patient was given water and vomited about 5 minutes later. Gave icepack and observed for another 30 minutes with no incident.


VAERS ID: 1415386 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-11
Onset:2021-06-21
   Days after vaccination:161
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PAA156051 / 2 RA / IM

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

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

Write-up: TESTED COVID POSITIVE ON 06/21/2021 AFTER FULL VACCINATED


VAERS ID: 1415390 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Paraesthesia, Syncope, Visual impairment
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Upon leaving the store approximately 15 minutes after receiving vaccination, patient told her father that she felt she was having an issue with her vision and was feeling faint. Her father was able to support her as she fainted and was lowered gently to the ground in front of the store. A pharmacy technician was leaving the store simultaneously and upon witnessing the event ran back to the pharmacy to tell me I was needed to assist. When I arrived, the patient was alert and breathing and able to answer questions regarding personal information, date, time and location. Patient stated she felt normal other than some tingling sensation in her hands. Patient reported that she hadn''t eaten anything since waking up that morning. EMS was already en route, and I observed the patient until they arrived. Patient has since been transported to the hospital and is currently reported in stable condition.


VAERS ID: 1415399 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Fall, Fatigue, Tremor, Vision blurred
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Glaucoma (broad), Lens disorders (broad), Retinal 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:
Current Illness:
Preexisting Conditions:
Allergies: amoxicillin, penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approximately 5 minutes after vaccination patient started slumping in chair. He was helped to the floor by his companion. He had blurred vision and mild shaking and kept asking what is going on. He was asked to lay down on the floor but chose to remain sitting on the floor. He was given a cold compress for his neck and stayed seated on the floor until he felt better. He stated that he was not dizzy, lightheaded but felt really tired. He recovered and stayed for about 15 minutes after recovering. He declined any medical attention and had a ride with his companion. He was advised to seek medical attention at the ER.


VAERS ID: 1415405 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821288 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Hyperhidrosis, Loss of consciousness, Nausea, Retching
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), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: patient alerted the technician that the patient stated he felt like he was going to pass out. He was visually sweating, clammy, and bending over. The pharmacist then instructed the patient to lean back in his chair and to breathe. next he started to lean to his side to pass out so the pharmacist grabbed him and held him up, the patient was unaware that he passed out. the patient was passed out for about 20 seconds and may have had a small seizure with no history of seizures on file. we applied a cold pack on the patient to help with the nausea he then dry heaved into the trash can. ems arrived and took patient to the hospital.


VAERS ID: 1415412 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Back pain
SMQs:, Retroperitoneal fibrosis (broad), Arthritis (broad)

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

Write-up: Patient arrived to observation room and approximately 25 minutes after receiving vaccine dose, patient with c/o pain in his right shoulder and back, which was the opposite side vaccine dose was given. Patient developed rash after first vaccine dose, 2 hours later. No treatment for first dose or hives per moms report. Patient given 25 mg benadryl at 1238. No visible rash when checked at 1240 and no other symptoms. At 1250, patient reported same symptoms. At 1303, patient reported pain much better. Patient left with mother shortly after and reported will take Tylenol as needed for any continued pain.


VAERS ID: 1415413 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperhidrosis, 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), 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: PT SAT ON THE BENCH AFTER RECEIVING MODERNA AND A COUPLE MINUTES LATER, WE HEARD A THUMP. PT PASSED OUT WITH HIS HEAD ON THE CONSULT ROOM DOOR AND WOKE UP SECONDS LATER WITH NAUSEA AND SWEATING. GAVE PT WATER AND MONITOR FOR 30 MINUTES. PT REFUSED MEDICAL HELP, NOTIFYING A FAMILY MEMBER AND FOOD.


VAERS ID: 1415419 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-06-20
Onset:2021-06-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Hypoaesthesia, Vaccine positive rechallenge
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)

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

Write-up: Patient experienced burning sensation throughout body after each dose of the covid-19 vaccine as well as facial numbness on the left side.


VAERS ID: 1415426 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Oropharyngeal pain, Throat irritation, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (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: Ibuprofen (contraindication)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient arrived to observation room and shortly after called observation RN over to him and reported that throat "feels funny, sore and tight, but not having difficulty breathing." RN administered 25 mg benadryl to patient and gave him water to make sure he could swallow. Patient had no difficulty swallowing benadryl. At 1240, patient reported no changes. At 1250, patient reported that he was "feeling better." At 1303, patient left with mom and reported feeling much better- no residual issues.


VAERS ID: 1415434 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042B21A / UNK - / -

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

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

Write-up: vaccine given 4 days early, no symptoms or adverse events


VAERS ID: 1415435 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Staring, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Paramedic stated that patient blacked out for 30 seconds and stated that patient was blankly staring ahead unresponsive. Patient states he has no past medical history except mole removal. EMS was called and took vitals on patient. BP 102/67. HR 72. O2 SAT 100%. Patient was the driver but brought a friend. Patient switched places with friend and had friend drive him home.


VAERS ID: 1415449 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 2 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dose 1 of Moderna was given on 04/22/2021 - client was 17 years old at the time.


VAERS ID: 1415457 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-06-16
Onset:2021-06-21
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1816022 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Omeprazole
Current Illness: none
Preexisting Conditions: heart murmur and iron deficiency
Allergies: Nitrite/Nitrates
Diagnostic Lab Data: no adverse reaction noted.
CDC Split Type:

Write-up: Pt was given Janssen Covid vaccine at age 17.


VAERS ID: 1415459 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821288 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Haemorrhage, Syncope, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: pt received Janssen vaccine around 10:28a. Patient was sitting in the post vaccination area. Around 3-5mins, he fainted, hit the floor. I ran out once this was brought to my attention. I found him on floor, blood on the floor and he was shaking and then stop. I don''t know how long he was shaking but it stop. I checked the pt and he regained conciousness. I asked if he is ok. He ask what happened because he does not remember. He speaks another language and an associate was there to translate. We asked if he wants us to call 911, he refused. The firefighter/paramedics suggested they will come over anyway to make sure he is ok, he does not have to go with them to go to the hospital. Pt did not want to go to hospital because he does not have insurance. He was checked by a medic who also speaks his language. He checked pt''s vital signs, asked questions like allergies, medical conditions, asked what day is today and what is his name (which were the same questions I asked before medic arrived). Medic informed patient the importance of seeing to a dr, the sooner the better. Pt still does not want to be taken to the hospital. Patient signed a refusal form. Nephew picked up the pt


VAERS ID: 1415460 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, Urinary incontinence
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: n/a
Current Illness: no
Preexisting Conditions: no
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient blacked out briefly while in waiting area and urinated. Patient was seated the entire time and did not fall to the floor.


VAERS ID: 1415465 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8729 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Dizziness, Exposure during pregnancy, Nausea, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (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: Situation: There was an Adverse reaction to the patient couple of minutes after her Pfizer Vaccine at 9:55 AM PST. The patient advised she felt nauseous and dizzy but she advised that she was pregnant also. At 10:20 AM HR 75, Oxygen 98%, Temp: 98.6, 102/70. At 10:35 AM HR 80, Oxygen 99%, Temp 98.9. At 10:40 AM HR 67, Oxygen 99%, Temp 98.9, 116/78 BP. She sat down since she was shaking and shivering and called her significant other since she was advised not to drive home. The patient indicated she had a Stomach infection that was not treated since she did not want to harm the baby. 10:45 AM She was released with her significant other and 911 was not called. Patient declined to have EMS activated and was informed by RN to seek medical attention upon discharge. Patient agreed to seek medical care.


VAERS ID: 1415473 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Feeling abnormal, Loss of consciousness, Pallor
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (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? 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: Undefined environmental
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient given vaccine then mother was given her vaccine. After RN administered vaccine to mother, patient reported he "felt weird." Patient suddenly got very pale in his face, so RN able to get patient to lie down and elevate feet. As patient was getting into supine position on exam table, patient passed out and was unconscious for one minute. A second RN entered room at the time and obtained vitals. Patient had strong pulse and was breathing upon assessment. Pulse ox upper 90s the entire time. Initial HR 50s, BPs 80s/40s. Within 10 minutes, HRs 60-70s and BPs 100s/50s. Patient was able to sit up independently, answered questions appropriately. Patient able to eat crackers and drink Gatorade with no issues. Patient able to stand without assistance and then escorted to observation room to be observed for an additional 30 minutes. Patient left with family with no further complications.


VAERS ID: 1415474 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Glossodynia, Swollen tongue, Throat irritation
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: patient went back to work and about an hour and so after receiving shot, pt felt like her tongue was swollen and painful and had an itchy throat. Her work EMT gave her Benadryl tablets and monitored her for a while. She said this took care of the effects


VAERS ID: 1415484 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 1 LA / IM

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

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

Write-up: Patient sat for a few minutes. Got up to go to the restroom and felt light headed and dizzy. He was hot then cold.


VAERS ID: 1415495 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-19
Onset:2021-06-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Rashes and swelling in hands


VAERS ID: 1415503 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821287 / N/A RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Loss of consciousness, Syncope
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), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Patinet received his Janssen Covid Vaccine today. He was fine in the immunization room and he went to the waiting area. Patient lost conciousness and fell on his partner. He regained conciousness in few seconds. He said he was feeling really lightheaded before he fell down. He had Syncope (Dizziness, and Loss of Consciousness for few seconds). He mentioned he did not drink much water today before the appt. We had him wait for 30 mins and he was fine when he left. Member of managements came to do an incident report and then he left. His partner was with him all the time.


VAERS ID: 1415506 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Balance disorder, Dizziness, Feeling hot, Nervousness, Urinary incontinence, Visual impairment
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Seven minutes after the patient received the Pfizer Dose 1 COVID-19 vaccination, patient started to feel nervous and hot. While waiting to receive some water she started complaining of being dizzy and wanted to lie down. The pharmacist escorted her to the immunization area and the patient became weak and started loosing her balance. She was put in a sitting position on the floor with her legs out. She then went into a blank stare to the ground, her hands flexed to her side, and wet herself. She became alert within seconds and was talking and acting normally. We called EMS and they transferred her to an emergency room for evaluation.


VAERS ID: 1415508 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Face injury, Fall, Loss of consciousness, Mouth injury, Pain in jaw, Tooth injury
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), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Osteonecrosis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No medications
Current Illness: None
Preexisting Conditions: None
Allergies: No allergies to medications, food or other products
Diagnostic Lab Data: Not available at this time
CDC Split Type:

Write-up: Patient received vaccine at 5:50pm and within 2 minutes while under the required 15 minute observation, he passed out and fell forward. Patient hit his chin and mouth breaking a tooth and complaining of jaw pain. Emergency services were called and paramedics checked all vitals and stated vitals were normal. Patient refused treatment and to be transported to Hospital. Patient has been seated and is still under observation by pharmacist. Patient left with father at 6:28 pm. Patient seems to be stable and pharmacist recommended to be taken to the hospital for further observation. Will be checking in with patient within the next few hours.


VAERS ID: 1415516 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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''s age has not been approved for Moderna yet. No adverse reactions reported 3 hours after vaccination, right before reporting this.


VAERS ID: 1415521 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 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: unknown age
Other Medications: Adderall, Pro Air
Current Illness: None
Preexisting Conditions: Asthma
Allergies: None
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient presented with parent for Pfizer Covid shot. Mother advised that the patient has a history of fainting after vaccines. Vaccine was administered, and approximately 1 minute later the patient did briefly faint. After regaining consciousness, we elevated his feet and gave him a cool rag and water to sip. Patient stayed in our vaccine room for about 15 minutes, reported he felt fine, and left.


VAERS ID: 1415533 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Posture abnormal, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (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: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt went limp immediately after vaccine administer. Seconds later head was shaking and pt returned to normal. Pt was observed by pharmacist and NP from clinic. Quad was called, pt was determined to be safe to go home with mother''s observation.


VAERS ID: 1415686 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 RA / IM

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

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

Write-up: Patient started feeling really nauseous after receiving the vaccine and had to lay down for about 15 minutes and drink some water. Patient did not need any medical attention. Patient had to call her husband to come and get her. Patient attributed it to her fear of needles.


VAERS ID: 1415694 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-18
Onset:2021-06-21
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Inflammatory marker increased, Troponin increased
SMQs:, Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: chest pain, elevated troponin, elevated inflammatory markers, admitted to the hospital.


VAERS ID: 1415695 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NA
Current Illness: None
Preexisting Conditions: Healthy
Allergies: NKDA
Diagnostic Lab Data: EMT arrived on scene and checked blood sugar and vitals. Patient signed waiver not to go to hospital. Patient was escorted to his vehicle by EMT to determine if able to drive home safely
CDC Split Type:

Write-up: Patient almost immediately fainted


VAERS ID: 1415698 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dizziness, Dyspnoea, Hypoaesthesia, Throat irritation
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient complained of feeling dizzy, itchy throat and feeling numb, chest tightness and difficulty breathing. Patient was given benadryl 12.5mg/5ml (given 30ml) initially but patient complained of difficulty breathing at that time she was given epipen injection 0.3mg. EMS was called and patient was taken to a local hospital


VAERS ID: 1415704 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Private       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: Sertraline, omeprazole
Current Illness: NA
Preexisting Conditions: Anxiety, Depression, GERD
Allergies: NA
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Patient was administered Moderna COVID19 vaccine outside of the age range supported by Emergency Use order. No adverse reactions noted day of administration.


VAERS ID: 1415706 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: No adverse events resulted. Patient received dose of Pfizer vaccine on May 21, 2021. Dose administered on 06/21/21 was Moderna Covid vaccine. Patient signed up for Moderna vaccine appointment, and verbally confirmed she was present for Moderna vaccine to both technician and pharmacist. The state registry does not differentiate between the two different mRNA vaccines. The patient presented her vaccine card after vaccination, which is when I noticed the vaccine administered was not compatible with the vaccine she received prior.


VAERS ID: 1415714 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 1 UN / IM

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

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

Write-up: Client received the 1st COVID vaccine (Moderna, Lot # 026C21A, EXP: 07/11/2021) at 14:20. EMT reported to PHN assistance with patient. Spouse of patient requested an emesis bag from PHN and stated that his spouse felt nausea. PHN approached patient at 14:27, patient is alert and oriented x 4, patient stated, ?I do not feel nauseated, it was only for a small second?. Patient asked if nausea was a normal symptom. Per fact sheet for recipients of Moderna vaccine, nausea is a common sign. Patient refused to be assessed by PHN or EMT. Patient was given water and encouraged to stay 30 minutes for observation, but patient refused the extended observation time. PHN advised client to follow up with primary care provider and gave ER precautions. Patient denies any further nausea and continues to refuse assessment. At 14:41 client left facility with a steady gait.


VAERS ID: 1415719 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyschromatopsia, Hypoacusis, Hypotension, Lethargy, Pallor, Syncope, Vision blurred
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (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), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Hypotonic-hyporesponsive episode (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: None reportec
Current Illness: None reported
Preexisting Conditions: None reported
Allergies: NKDA
Diagnostic Lab Data: BP around 11:15AM 81/46
CDC Split Type:

Write-up: 17 year old female received Pfizer COVID vaccine and was told to sit and wait 15 minutes for monitoring after the shot. Patient attempted to leave before the time elapsed with her father and collapsed in the aisle. She was able to be assisted to a nearby chair and 911 was called. I was told she did not hit her head or any other part of her body when she fell. I attempted to take her blood pressure, but it was too low. Patient appeared very pale and was responsive but stated she was seeing black and couldn''t hear properly. She did not eat anything that morning. Patient continued to talk and answer questions updating me on her improvements but still appeared very lethargic and eyes were not focused. EMTs arrived and her BP was 81/46. EMTs, store management and health care ambassador remained with patient. Patient began to feel better and did not go to the hospital. EMTs left and management and associate remained with patient. Once patient felt better, she walked out of the pharmacy/store with her father.


VAERS ID: 1415728 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1816022 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Epistaxis, Head injury, Loss of consciousness, Skin discolouration, Swelling face
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), 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? No
Hospitalized? No
Previous Vaccinations: After he came around, he admitted that about 15 years ago, he had fainted from a shot. He did not know what the shot was....vac
Other Medications: Not known
Current Illness: None known
Preexisting Conditions: None known
Allergies: NKA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pt received the vaccination at approximately 4:25pm on 6/21/2021. Pharmacist went over potential side effects before administration. Pharmacist administered the vaccine, filled out his paperwork, and then stood up. Pt stood up. Pharmacist started to ask him to wait in the pharmacy waiting area for 15 minutes so we could make sure that he did not have a reaction. Before the pharmacist could finish, the Patient started to sway. He leaned against the wall, started to bend over, hit his head on the wall, and passed out. The pharmacist called for help from the other staff. Pt''s legs were lifted up so that his feet were resting on the chair. He had hit the bridge of his nose against the wall/side of door. His nose was swelling up, turning black and blue, and was starting to bleed. After about 15 seconds, the patient came around. He was able to answer questions coherently. He stated that he did not need an ambulance. Pharmacist retrieved a couple of ice packs for him and put his coat under his head. Patient remained lying down for approximately 30 minutes before he stood up. When he stood up, he did not sway and seemed stable. Pt declined the pharmacy staff to contact someone to drive him home.


VAERS ID: 1415729 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 1 AR / 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: administered to person under age 18


VAERS ID: 1415738 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / 1 LA / IM

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

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

Write-up: PT FELT IMMEDIATE SYNCOPE, FAINT, DIZZINES, WAS SWEATING PROFUSELY


VAERS ID: 1415942 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 3 LA / IM

Administered by: Pharmacy       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? 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 received a third dose of covid vaccine by mistake. no immediate reaction and observed for 30 minutes. patient reported to be fine and not experiencing any signs or symptoms. educated patient that the following day will most likely feel like they did after receiving the second dose.


VAERS ID: 1415944 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-17
Onset:2021-06-21
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 LA / IM

Administered by: School       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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient was 17 years old at the time of the first COVID-19 vaccination. Facility has a signed parental consent form on file. At patient''s second dose appointment, patient and mother were made aware that Moderna COVID-19 vaccines have not been FDA approved for anyone under 18 years old. Per continuity of care and physician clearance with mother''s consent , the patient received the second dose of Moderna vaccine. Patient informed the Vaccine Coordinator that she only experienced a sore left arm and redness at the injection site after her first dose of Moderna Covid-19 vaccine. The Vaccine Coordinator recognized the patient was a minor at appointment check-in time for her second dose, as her first dose was administered a month ago without realizing her age. Vaccine coordinator spoke with the Medical Director regarding the situation and was given approval to have phamacist administer the second dose.


VAERS ID: 1415946 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dyspnoea, Fall, Loss of consciousness, Muscle twitching, Seizure, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Dyskinesia (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), 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? 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 was given the vaccination and asked to remain in the consultation area for 15 mins. The pharmacy student that administered the vaccination walked turned to walk away when he heard bumping on the wall of the room. He turned to see the patient with his head back and eyes wide open. He returned to the room and called the patient''s name with no response. The patient at this point had his eyes shut and seemed to slump in the chair. His breathing was labored and then seemed to stop. His pulse was still felt. The patient was unconscious and seemed to be seizing. An Epipen administered in the right thigh. The patient seemed to twitch and immediately regained consciousness. At this point the EMT arrived and took over. The patient seemed unaware of the events and was fully recovered.


VAERS ID: 1415947 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-20
Onset:2021-06-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 2 LA / IM

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

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

Write-up: pt called the pharmacy to let us know that the day after receiving second covid 19 dose, she has a rash from head to toe


VAERS ID: 1415949 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-05-22
Onset:2021-06-21
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Arrhythmia, Blood test, Chest X-ray, Chest pain, Chills, Dyspnoea, Electrocardiogram, Eye swelling, Fatigue, Headache, Heart rate irregular, Nausea, Pain, Palpitations, Pyrexia
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Amoxicillin Loratab Codeine Percocet
Diagnostic Lab Data: June 21st 2021: EKG, Bloodwork, Chest X-ray (results to be determined. Dr found a small heart arrhythmia
CDC Split Type:

Write-up: 1st shot: headache, nausea, fever, chills, fatigue, chest pain, racing heart, increased anxiety (may 22nd 2021) may 23rd 2021 - june 19th 2021: continued heart racing, irregular heart rate, chest pain, hyperventilating, hard time catching breath. heart rate between 98-150bpm 2nd shot: headache, chills, body aches, eyes swelling, face swelling, chest pains, irregular heart rate, nausea, fatigue. (june19th 2021) june 20th 2021 - now: sharp chest pains, heart racing, hard time catching breath.


VAERS ID: 1415955 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 3 LA / SYR

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

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

Write-up: DUE TO MISCOMMUNICATION, PATIENT WAS ACCIDENTLY VACCINATED WITH A 3RD DOSE OF PFIZER VACCINE (ONE IN APRIL, ONE IN MAY, AND ONE IN JUNE)


VAERS ID: 1415957 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

Administered by: Pharmacy       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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient denoted that she had not yet had the COVID vaccine. Vaccination itself went without issue. Upon attempting to bill for the administration, a third party rejection indicated she got the J&J vaccine already. I confirmed this using the immunization registry that she received this on 3/13/21. Patient has been notified she is not to receive another dose.


VAERS ID: 1415958 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821287 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Nausea, Presyncope
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Neusea, almost collaspe


VAERS ID: 1415962 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

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

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

Write-up: Patient denoted that he had not yet had the COVID vaccine. Vaccination itself went without issue. Upon attempting to bill for the administration, a third party rejection indicated he got the J&J vaccine already. I confirmed this using the immunization registry that she received this on 3/13/21. Patient has been notified she is not to receive another dose.


VAERS ID: 1415965 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: FEELING DIZZY
Other Medications: NO
Current Illness: NO
Preexisting Conditions: NO
Allergies: NO
Diagnostic Lab Data: ONLY VITAL SIGN WAS TAKEN: BP 106/69
CDC Split Type:

Write-up: when patient got the vaccine she had instant drop of blood pressure, felt so dizzy but not had any breathing issue. no treatment was given to the patient. After few minutes patient was about to talk and felt fine. Her blood pressure come up to 106/69 and was able to go home.


VAERS ID: 1415968 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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

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

Write-up: Upon administering 1st dose of Pfizer vaccine for patient once the needle was in the patient''s arm and I started to push on the plunger the vaccine squirted out of where the needle screws on to the syringe body. In my opinion most of the vaccine sprayed on her arm and very little if any of the vaccine was actually administered into her arm. I cleaned up the liquid on her arm and re-vaccinated with another syringe to ensure she received the proper 0.3ml dose of the vaccine. I administered the vaccine in the same arm.


VAERS ID: 1415971 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-07
Onset:2021-06-21
   Days after vaccination:106
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Dyspnoea, Inflammation, Joint swelling
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pneumonia vaccine 24
Other Medications: 0
Current Illness: 0
Preexisting Conditions: 0
Allergies: 0
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Next day I had breathing problems followed by lots of inflammation all over my body. All my joints swelled and burned.. following the second vaccine I have excruciating painful joints throughout my body that has not gone away. I have zero history of this. I still have it today. 6-21-2021


Result pages: prev   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178   next

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?EVENTS=ON&PAGENO=79&PERPAGE=100&ESORT=ONSET-DATE&REVERSESORT=ON&VAX=COVID19&DIED=No


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166