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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 88 out of 4,799

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VAERS ID: 1467210 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-20
Onset:2021-06-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Public       Purchased by: ?
Symptoms: Amenorrhoea
SMQs:, Fertility disorders (broad)

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

Write-up: Missed menstruation, I should have gotten it by June 25


VAERS ID: 1467288 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-01-07
Onset:2021-06-20
   Days after vaccination:164
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: C-reactive protein normal, Mobility decreased, Myalgia, Pain, Polymyalgia rheumatica, Red blood cell sedimentation rate increased
SMQs:, Rhabdomyolysis/myopathy (broad), Parkinson-like events (broad), Eosinophilic pneumonia (broad), Vasculitis (narrow), Tendinopathies and ligament disorders (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: losartin, omeprazole, saw palmeto
Current Illness:
Preexisting Conditions: htn, gerd, barretts
Allergies: nka
Diagnostic Lab Data: sedimentation rate - 26 mm/hr (0-20) c-reactive protein - 0.90 mg/dL (less than 0.50) pending Lyme Titre Started on course of Prednisone 20mg x10 days, then 10 mg until next visit with at
CDC Split Type:

Write-up: acute proximal extremity muscle pain with movement. difficulty ambulating. no muscle weakness or joint pain. diagnosed with "polymyalgia rheumatica."


VAERS ID: 1467298 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-19
Onset:2021-06-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Depression, Headache, Heavy menstrual bleeding, Pain, Pyrexia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Depression (excl suicide and self injury) (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: No
Current Illness: high blood pressure
Preexisting Conditions: hypothyroidism (taking synthroid and cytomel).
Allergies: Almond, cherry, lychee
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Beginning 6/20/2021 at 7:00am: low fever for 2 days, body aches for 4 days, stomach pain 4 days, serious headache for 6 days. Still have headache from time to time. heavy period for 12 days. depression still on 7/12/2021.


VAERS ID: 1470269 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-17
Onset:2021-06-20
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: PERICARDITITIS THAT RESULTED IN ER VISIT AND CONSULTATION WITH CARDIOLOGIST. DID NOT RESULT IN HOSPITALIZATION.


VAERS ID: 1470407 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2020-12-19
Onset:2021-06-20
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EH9899 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Tympanic membrane perforation
SMQs:, Accidents and injuries (broad), Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Ear drum rupture


VAERS ID: 1470576 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-19
Onset:2021-06-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO191 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Blood test abnormal, Culture stool, Diarrhoea, Dyspnoea, Fatigue, Haematochezia, Heart rate increased, Inflammation, Pyrexia, Ultrasound scan, X-ray
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: multivitamin
Current Illness: sore throat with fever earlier in the week that cleared several days before the second dose of the Pf izer Covid vaccine Patient got her 1st dose on 5/26/2021
Preexisting Conditions: none known
Allergies: none
Diagnostic Lab Data: ER visit, blood work showed inflammation, xray and sonogram of abdominal area and fecal done. Referred to GI specialist. Cardiac isssues are prominent problem as of July 12 so we have put GI tests on hold until we see cardiologist on 7/20. Taking Flagyl for diarrhea and that has helped.
CDC Split Type:

Write-up: Beginning on the day after thee 2nd shot:severe stomach pain, fever, fatigue, bloody loose stool, fever went away after several days but digestive problems persisted. Elevated heart rate gradually beginning to be noticeable and bothersome with a feeling of being "winded". This also was totally out of character for my daughter who is a runner. She has never had any symptoms like this before.


VAERS ID: 1471021 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-14
Onset:2021-06-20
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 15129 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Antibiotic therapy, Bronchitis, Chest X-ray
SMQs:

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: alprazolam, progesterone, Alavert
Current Illness: none
Preexisting Conditions: none
Allergies: codeine, penicillin, diflucan, statins for cholesterol
Diagnostic Lab Data: Chest Xray-July 9, 2021
CDC Split Type:

Write-up: Bronchitis, steroid pack, then antibiotics.


VAERS ID: 1471472 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-06-18
Onset:2021-06-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW O175 / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Heart rate increased, Injection site pruritus, Lip swelling, Pruritus, Swelling face, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu
Other Medications: Zyrtec, Pepcid, Singulair, Benadryl, Flonase, cromolyn sodium, Liquid IV, and Vitamin C
Current Illness: Mast cell activation syndrome, asthma, Ehlers-Danlos
Preexisting Conditions: Mast cell activation syndrome, asthma, Ehlers-Danlos
Allergies: Erythromycin, cipro, bactrim, plaquenil, tetracycline, Clindamycin
Diagnostic Lab Data: None. I do have some images.
CDC Split Type:

Write-up: Oh I noticed around 11 that I had a very itchy spot on my arms near the injection site but also on my neck, shoulder, my left arm, knees, stomach, breasts, and thighs. I Then check out areas that are itching and is raised urticaria. They got worse over the next few days. I also had some lip swelling and swelling around my jaw as well as some elevated heart rate. I called my doctors office and they prescribed me prednisone for five days to resolve the overactive immune issue. I have this happen a lot.


VAERS ID: 1474166 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-01-08
Onset:2021-06-20
   Days after vaccination:163
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram, Electroencephalogram, Laboratory test, Magnetic resonance imaging, Scan with contrast, Toxicologic test, Transient global amnesia
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: Influent Pump Cyntroid 100micrgram Alsena 60mg once daily Lusuvastatin 20mg once daily Humara 40mg once weekly
Current Illness: None
Preexisting Conditions: Type I Diabetes Hypothyroid Rhuematoid Arthritis
Allergies: None
Diagnostic Lab Data: MRI EEG MRA with and without contrast Toxicology Screen General Labs
CDC Split Type: vsafe

Write-up: On the morning of Jume 20 I woke up and didn''t know where I was. I was given a diagnoses of transent global amnesthia.


VAERS ID: 1474323 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-17
Onset:2021-06-20
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW9172 / 1 LA / IM

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

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

Write-up: WHEN HE CAME BACK FOR HIS 2ND DOSE ON 6/20/21, HE MENTIONED THAT THE 1ST VACCINE GAVE HIM A RASH. IT STARTED APPROXIMATELY ON 6/20/21 ON HIS UPPER BACK. HE DID STATE THAT HE WAS DOING YARD WORK THE DAY BEFORE THE RASH STARTED, AND HE SAID IT DID LOOK LIKE A HEAT RASH. HE NEVER SAW A DOCTOR FOR IT, IT RESOLVED ON ITS OWN. HE DID RECEIVED THE 2ND DOSE ON 7/8/2021. HE WILL REACH OUT TO ME IF IT HAPPENS AGAIN, SO I WON''T UPLOAD THIS UNTIL NEXT WEEK.


VAERS ID: 1475209 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-04-09
Onset:2021-06-20
   Days after vaccination:72
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8734 / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Fatigue, Headache, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid, atorvastatin, multi vitamin, fiber supplement, fish oil, b12, d3, baby aspirin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: CVS minute clinic walk in
CDC Split Type:

Write-up: Positive COVID diagnosis 6/24/2021. Headache, congestion, fever, tiredness


VAERS ID: 1420470 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-18
Onset:2021-06-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blepharospasm, Dizziness, Hypoaesthesia, Ocular hyperaemia, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Vestibular disorders (broad), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow)

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

Write-up: Pulsating of left eyelid and redness of eye. The pulsating stopped Monday the 21st in the evening. Tingling sensation (needle-like) that felt like it traveled through the body on and off. Mild intermittent dizziness. Sensation of numbness in face which comes and goes, this complaint is still ongoing.


VAERS ID: 1452568 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-20
Onset:2021-06-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Maternal exposure during pregnancy, Nausea, SARS-CoV-2 test, Scan
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: FOLIC ACID
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Lactation decreased
Allergies:
Diagnostic Lab Data: Test Date: 20210620; Test Name: COVID-19 virus test; Result Unstructured Data: Test Result:No - Negative COVID-19 test; Test Name: scans; Result Unstructured Data: Test Result:Baby has no issues
CDC Split Type: GBPFIZER INC2021746994

Write-up: Felt faint/Dizziness; Nauseous; Maternal exposure during pregnancy/exposed to the medicine Second-trimester (13-28 weeks); This is a spontaneous report from a contactable consumer (patient) received from the Regulatory Agency. Regulatory authority report number GB-MHRA-WEBCOVID-202106202103063260-3QAZQ, Safety Report Unique Identifier GB-MHRA-ADR 25506700. A 28-year-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, lot number: unknown), via an unspecified route of administration on 20Jun2021 (at the age of 28 years old) as DOSE 1, SINGLE for COVID-19 immunisation. Medical history included lactation decreased. Patient has not had symptoms associated with COVID-19. Patient is not enrolled in clinical trial. Patient is not currently breastfeeding. Concomitant medication included folic acid taken for folic acid supplementation. The patient experienced felt faint/dizziness and nauseous on 20Jun2021 since having the vaccine. The events were medically significant. The patient also experienced maternal exposure during pregnancy/exposed to the medicine second-trimester (13-28 weeks). Baby has no issues according to scans. The patient underwent other lab tests and procedures which included COVID-19 virus test was no - negative COVID-19 test on 20Jun2021. Patient has not tested positive for COVID-19 since having the vaccine. Outcome of the felt faint/dizziness and nauseous was not recovered. No follow-up attempts are possible; information about lot/batch number cannot be obtained.


VAERS ID: 1452618 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-20
Onset:2021-06-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA1027 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: SARS-CoV-2 test, Seizure, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), COVID-19 (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: Medical History/Concurrent Conditions: Pregnancy; T3 decreased; Vitamin B12 decreased
Allergies:
Diagnostic Lab Data: Test Date: 20210105; Test Name: COVID-19 virus test; Result Unstructured Data: Test Result:Yes - Positive COVID-19 test; Comments: Yes - Positive COVID-19 test
CDC Split Type: GBPFIZER INC2021747343

Write-up: seizure; Fainting; This is a spontaneous report from a contactable consumer received from the Regulatory Agency (RA). The regulatory authority report number is GB-MHRA-WEBCOVID-202106202237116340-9VPQT. Safety Report Unique Identifier GB-MHRA-ADR 25506867 A 17-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) , via an unspecified route of administration on 20Jun2021 (Batch/Lot Number: FA1027), at the age of 17-years-old, as dose 1, single for Covid-19 immunisation. Medical history included pregnancy, T3 decreased and low B12. The patient is normally fit and well. Patient has not had symptoms associated with COVID-19. Patient is not enrolled in clinical trial. The patient''s concomitant medications were not reported. The patient experienced seizure on an unspecified date with outcome of unknown and fainting on 20Jun2021 with outcome of recovered on 20Jun2021. The patient underwent lab test which included Covid-19 virus test: yes - positive covid-19 test Yes - Positive COVID-19 test, on 05Jan2021. The events were assessed as serious and medically significant by regulatory authority. The clinical course was reported as follows: Fainting within 5 minutes and having a seizure. Patient has not tested positive for COVID-19 since having the vaccine. Adverse reaction did not occur as a result of an exposure during pregnancy. No Follow-up attempts are needed. No further information is expected.


VAERS ID: 1452638 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-19
Onset:2021-06-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Back pain, Fatigue, Pain, Vaccination site pain
SMQs:, Retroperitoneal fibrosis (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: Medical History/Concurrent Conditions: Lactation decreased
Allergies:
Diagnostic Lab Data:
CDC Split Type: GBPFIZER INC2021747552

Write-up: tiredness; Back pain; slight ache; slight pain at injection site; This is a spontaneous report from a contactable consumer. This is a report received from the Regulatory Agency (RA). The regulatory authority report number is GB-MHRA-WEBCOVID-202106210153021660-8S8AX, safety report unique identifier: GB-MHRA-ADR 25507107. A 16-year-old female patient received BNT162B2 (COVID-19 MRNA VACCINE BIONTECH), via an unspecified route of administration on 19Jun2021 (at the age of 16 years), dose 2, single for COVID-19 immunisation. Medical history included suppressed lactation. Not had a COVID-19 test. Patient is not enrolled in clinical trial. Patient is not pregnant nor currently breastfeeding. The patient''s concomitant medications were not reported. Patient reported that on 20Jun2021, the first day, she was fine with slight pain at injection site. On second day, 21Jun2021, slight ache and tiredness (all expected), following evening back pain that progressively worsened. The events were considered medically significant. Patient has not tested positive for COVID-19 since having the vaccine. Outcome of the event fatigue was unknown and outcome of the remaining events was not recovered. No follow-up attempts are possible, Information about Batch/Lot Number cannot be obtained.


VAERS ID: 1456826 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-06-20
Onset:2021-06-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA9093 / 1 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Eye swelling, Product administered to patient of inappropriate age
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Medication errors (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CAPFIZER INC2021766748

Write-up: left eye swollen almost shut; Patient 15 years old; This is a spontaneous report from a contactable consumer, the patient, received via regulatory authority. A 15-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE, lot FA9093, first dose) solution for injection intramuscular in the left arm on 20Jun2021 at 15:00 (at the age of 15-years-old) as a single dose for COVID-19 vaccination. Medical history was not reported. There were no concomitant medications. The patient did not receive any other vaccine within 4 weeks prior to the COVID vaccine. Prior to the vaccination, the patient was not diagnosed with COVID-19. On 20Jun2021 at 19:00, 4 hours after vaccine, the patient left eye swollen almost shut. A doctor or other healthcare professional office/clinic visit was required. Treatment for the event eye swollen included diphenhydramine (BENADRYL). The outcome of the event eye swollen was recovered with sequel in Jun2021. Since the vaccination, the patient has not been tested for COVID-19.


VAERS ID: 1462208 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-15
Onset:2021-06-20
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC8289 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Abortion spontaneous
SMQs:, Termination of pregnancy and risk of abortion (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: FOLIC ACID
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Folic acid supplementation; Miscarriage; Pregnancy (Patient no longer pregnant at the time of reporting.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: GBPFIZER INC2021772933

Write-up: Early miscarriage/miscarriage; This is a spontaneous report from a contactable physician received from the Regulatory Agency (RA). The regulatory authority report number is GB-MHRA-WEBCOVID-202106211300215240-IVGHZ. Safety Report Unique Identifier GB-MHRA-ADR 25510221. A 32-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, lot FC8289), via an unspecified route of administration on 15Jun2021 as dose 1, single for Covid-19 immunisation. Medical history included miscarriage on Mar2021, pregnancy and folic acid supplementation. Concomitant medication included folic acid for vitamin supplementation, start and stop date were not reported. The patient was exposed to the medicine first-trimester (1-12 weeks). The patient was not aware of pregnancy at time of first dose of vaccine and on 20Jun2021, she had sustained a miscarriage. Patient has not tested positive for COVID-19 since having the vaccine. The outcome of event was unknown. No follow-up attempts are possible. No further information is expected.; Sender''s Comments: Linked Report(s) : GB-PFIZER INC-2021792967 fetus/baby case


VAERS ID: 1468424 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-20
Onset:2021-06-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Axillary pain, Chills, Hyperhidrosis, Nausea, Swelling, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (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: Medical History/Concurrent Conditions: Lactation decreased
Allergies:
Diagnostic Lab Data:
CDC Split Type: GBPFIZER INC2021796576

Write-up: Underarm feels swollen and sore; Underarm feels swollen and sore; Vomiting; Chills; Sweats; Nausea; This is a spontaneous report from a contactable consumer downloaded from the WEB. The regulatory authority report number is GB-MHRA-WEBCOVID-202106222318004640-PTI8J (Safety Report Unique Identifier: GB-MHRA-ADR 25521960). A non-pregnant 17-year-old female patient received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE; Lot Number was not reported), via an unspecified route of administration, on 20Jun2021 (at the age of 17 years), as dose 2, single, for COVID-19 immunization. The patient''s medical history included lactation decreased (unknown if ongoing). The patient''s concomitant medications were not reported. The patient has not had symptoms associated with COVID-19 and had not had a COVID-19 test. The patient was not enrolled in clinical trial and is not currently breastfeeding. On 20Jun2021 (12 hours after vaccination), vomiting started and continued for 5 or 6 hours. On 20Jun2021, the patient experienced chills and sweats during the vomiting period (12 hours after vaccination). Nausea feeling on 20Jun2021 continued for further 6 hours after vomiting ceased. On 21Jun2021, the patient''s underarm feels swollen and sore. The patient has not tested positive for COVID-19 since having the vaccine. The events were considered serious as important medical conditions. The patient had not recovered from "Underarm feels swollen and sore". The patient was recovering from "Nausea". The patient recovered from the remaining events on 21Jun2021. No follow-up attempts are possible; information about lot or batch number cannot be obtained.


VAERS ID: 1471823 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-20
Onset:2021-06-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC5435 / 1 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure measurement, Body temperature, Heart rate, Nausea, Oxygen saturation, Syncope
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? Yes
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: Test Date: 20210620; Test Name: blood pressure; Result Unstructured Data: Test Result:60/20 mmHg; Test Date: 20210620; Test Name: blood pressure; Result Unstructured Data: Test Result:100/50 mmHg; Test Date: 20210620; Test Name: body temperature; Result Unstructured Data: Test Result:afebrile; Test Date: 20210620; Test Name: heart rate; Result Unstructured Data: Test Result:69 bpm; Test Date: 20210620; Test Name: saturation; Test Result: 98 %
CDC Split Type: FRPFIZER INC2021817716

Write-up: Syncope vasovagal; nausea; This is a spontaneous report from a contactable physician downloaded from the regulatory authority, regulatory authority number FR-AFSSAPS-2021082678. A 15-years-old female patient received first dose of BNT162B2 (COMIRNATY, PFIZER-BIONTECH COVID-19 VACCINE, formulation: solution for injection, lot number: FC5435, expiration date: unknown) intramuscular, administered in arm left on 20Jun2021 as 0.3 ML single dose for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. Patient was not considered to be at risk of developing severe form of COVID-19 disease. COVID-19 test was not performed. 1 minute after the injection, the patient becomes unwell without loss of consciousness, then another faint with brief loss of consciousness. The patient was hypotensive (60/20 mmHg), bradycardic and presents with nausea. She was transferred to the emergency room for surveillance. On arrival, her condition improved: Blood pressure at 100 / 50mmHg, heart rate at 69 bpm, Saturation: 98% AA (ambient air) and she was afebrile. The diagnosis of vagal discomfort was retained. She received no treatment (no epinephrine, no antihistamine treatment). She was allowed to return to her home the same day. In total, onset, in a 15-year-old adolescent girl with a history of malaise after vaccination, of vasovagal syncope 1 minute after Dose 1 of the COMIRNATY vaccine. The outcome of the events was recovered on 20Jun2021. Assessed syncope vasovagal/Comirnaty. Did reaction recur on readministration? (NO -- N/A (no rechallenge was done, recurrence was not applicable)) No follow-up attempts are possible. No further information was expected.


VAERS ID: 1472308 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-06-20
Onset:2021-06-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA5843 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Lymphadenopathy, Peak expiratory flow rate, SARS-CoV-2 test, 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), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: peak flow; Result Unstructured Data: Test Result:400; Test Name: COVID-19 virus test; Result Unstructured Data: Test Result:No - Negative COVID-19 test
CDC Split Type: GBPFIZER INC2021772576

Write-up: Swollen glands; felt weak; Fainting; This is a spontaneous report from a contactable consumer (patient''s parent). This is a report received from the Regulatory ARA). The regulatory authority report number is GB-MHRA-WEBCOVID-202106212154022040-KLOGC, Safety Report Unique Identifier GB-MHRA-ADR 25516212. An 18-year-old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, Lot Number: FA5843), via an unspecified route of administration on 20Jun2021 (at the age of 18 years old) as first dose, single for COVID-19 immunisation. The patient''s medical history was not reported. The patient is a football player, fit and well. Patient has not had symptoms associated with COVID-19. Patient is not enrolled in clinical trial. Concomitant medication included new medication inhaler (it''s pink). On 20Jun2021, the patient experienced fainting and felt weak. On 21Jun2021, the patient experienced swollen glands. The patient''s parent reported, "My son is an 18 year old fit and well. Not anxious about the jab. Fainted 10 mins after having the jab. He had eaten beforehand. He felt weak and went to bed all day. When he woke his gland on the right side (opposite to injection site) had swollen. He is resting and awaiting 111 to call him back to discuss." The patient underwent lab tests and procedures which included covid-19 virus test: No - Negative COVID-19 test and peak flow: 400 on unspecified dates. Patient has not tested positive for COVID-19 since having the vaccine. Outcome of the event fainting was recovered on 20Jun2021. Outcome of the event swollen glands was not recovered. Outcome of the event felt weak was unknown. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1475553 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-06-20
Onset:2021-06-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0168 / 1 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Blood glucose, Blood pressure measurement, Blood pressure systolic, Body temperature, Disorientation, Heart rate, Hyperhidrosis, Hypotension, Malaise, Pallor, Physical examination, Presyncope, Vaccination site pain, Vision blurred, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments:
Allergies:
Diagnostic Lab Data: Test Date: 20210620; Test Name: capillary blood glucose; Result Unstructured Data: Test Result:1.13; Comments: at the time of the episode; Test Date: 20210620; Test Name: capillary blood glucose; Result Unstructured Data: Test Result:0.89; Comments: Upon their arrival at the Emergency Room; Test Date: 20210620; Test Name: Blood Pressure; Result Unstructured Data: Test Result:6/4; Comments: at the time of the episode; Test Date: 20210620; Test Name: Blood Pressure; Result Unstructured Data: Test Result:up to 10; Comments: at the time of the episode: Systolic blood pressure 6/4 then 8 then 10; Test Date: 20210620; Test Name: Blood Pressure; Result Unstructured Data: Test Result:10/50; Comments: Upon their arrival at the Emergency Room; Test Date: 20210620; Test Name: Systolic blood pressure; Result Unstructured Data: Test Result:6/4; Test Date: 20210620; Test Name: Systolic blood pressure; Result Unstructured Data: Test Result:8; Test Date: 20210620; Test Name: Systolic blood pressure; Result Unstructured Data: Test Result:10; Test Date: 20210620; Test Name: body temperature; Result Unstructured Data: Test Result:36.2 Centigrade; Test Date: 20210620; Test Name: Pulse; Result Unstructured Data: Test Result:57; Test Date: 20210620; Test Name: Pulse; Result Unstructured Data: Test Result:62; Test Date: 20210620; Test Name: Pulse; Result Unstructured Data: Test Result:54; Comments: bpm at the time of the episode; Test Date: 20210620; Test Name: Pulse; Result Unstructured Data: Test Result:65; Comments: bpm Upon their arrival at the Emergency Room; Test Date: 20210620; Test Name: physical examination; Result Unstructured Data: Test Result:description; Comments: Cardiology: regular heart bruits, no murmur, no signs of right or left cardiac insufficiency, no oedema, pulse perceived. Pneumological: Bilateral symmetrical vesicular murmur, clear auscultation Digestive: abdomen: soft, yielding and painless. Neurological: integral cranial nerves
CDC Split Type: FRPFIZER INC2021796129

Write-up: sweats; feeling of imminent malaise; disorientation; Hypotension; Vagal reaction; blurry vision; pallor; vomiting; pain in the vaccinated arm; This is a spontaneous report from a contactable physician downloaded from the regulatory authority, regulatory authority number FR-AFSSAPS-2021079110. A 12-year-old male patient received bnt162b2 (COMIRNATY; Batch/Lot Number: FD0168), dose 1 intramuscular on 20Jun2021 (at the age of 12-years-old) as dose 1, single for COVID-19 immunisation. The patient''s medical history and concomitant medications were not reported. The patient previously took orelox and experienced allergy (skin rash a few hours after taking it 1 and a half years ago). On 20Jun2021 the patient experienced hypotension, vagal reaction, blurry vision, pallor, feeling of imminent malaise, disorientation and vomiting. On 21Jun2021 the patient experienced pain in the vaccinated arm and on an unspecified date sweats. The events required hospitalization. The events were described as vagal discomfort with no loss of consciousness, disorientation, pallor, vomiting, blood pressure dropped and did not go back up. Duration of the reaction: 1 hour. Ongoing medical care: Urgent medical intervention/life threatening/Hospitalization. A few minutes later vaccination: blurry vision with pallor and sweats and a feeling of imminent malaise. Ongoing medical care at the vaccination centre: laid down with raised legs, feeling of buzzing ears, eyes open during the entire episode but did not respond to stimulations and did not remember the episode. The mother thought she saw the eyes contort, no abnormal movements, no tongue biting, no loss of urine. + While changing room: 1 episode of vomiting (food) + new feeling of malaise. Since then, he remains very asthenic. Vital signs at the time of the episode: Systolic blood pressure 6/4 then 8 then 10, 54bpm, capillary blood glucose 1.13. On 21Jun2021: no symptoms, resolution with no sequelae, only pain in the vaccinated arm, no cardiac/neurological disorders after examinations. Upon their arrival at the Emergency Room: Blood pressure 10/50; 65bpm; capillary blood glucose 0.89, T 36.2 C degree. No personal or family cardiac or epileptic medical history. No fever, no recent infection. Patient''s personal treatment: None. Clinical examination on admission: Cardiology: regular heart bruits, no murmur, no signs of right or left cardiac insufficiency, no oedema, pulse perceived. Pneumological: Bilateral symmetrical vesicular murmur, clear auscultation Digestive: abdomen: soft, yielding and painless. Neurological: integral cranial nerves''''. In conclusion, the patient presented with vagal discomfort following their vaccination. The patient underwent lab tests and procedures which included blood glucose: 1.13 on 20Jun2021 at the time of the episode, blood glucose: 0.89 on 20Jun2021 upon their arrival at the emergency room, blood pressure measurement: 6/4 on 20Jun2021 at the time of the episode, blood pressure measurement: up to 10 on 20Jun2021 at the time of the episode: Systolic blood pressure 6/4 then 8 then 10, blood pressure measurement: 10/50 on 20Jun2021 upon their arrival at the emergency room, blood pressure systolic: 6/4 on 20Jun2021, blood pressure systolic: 8 on 20Jun2021, blood pressure systolic: 10 on 20Jun2021, body temperature: 36.2 centigrade on 20Jun2021, heart rate: 57 on 20Jun2021, heart rate: 62 on 20Jun2021, heart rate: 54 on 20Jun2021 bpm at the time of the episode, heart rate: 65 on 20Jun2021 bpm upon their arrival at the emergency room, physical examination on 20Jun2021 showed Cardiology: regular heart bruits, no murmur, no signs of right or left cardiac insufficiency, no oedema, pulse perceived. Pneumological: Bilateral symmetrical vesicular murmur, clear auscultation. Digestive: abdomen: soft, yielding and painless. Neurological: integral cranial nerves. The outcome of events hypotension and vagal reaction was recovering, the outcome of the other events was unknown. No follow-up attempts are needed. No further information is expected.


VAERS ID: 1412621 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-18
Onset:2021-06-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Public       Purchased by: ?
Symptoms: Dyspnoea, Pain, Pyrexia, Sinus congestion
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lexapro
Current Illness: None
Preexisting Conditions: Anxiety/OCD mental health problems
Allergies: Acetaminophen
Diagnostic Lab Data: None Taken Yet
CDC Split Type:

Write-up: At around 5 am, I woke up with severe trouble breathing and extreme sinus congestion. Also have some body aches and feel feverish. It has been going on for over an hour now and not going away.


VAERS ID: 1412707 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-06-18
Onset:2021-06-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

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

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

Write-up: Chills, fever, severe ,headache, muscle pain


VAERS ID: 1412731 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (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: Similar reaction to HPV
Other Medications: None
Current Illness: None reported
Preexisting Conditions: None reported
Allergies: Multiple antibiotics, HPV vaccine
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Minimal Buffalo swelling. Resolved with ice and diphenhydramine.


VAERS ID: 1412738 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-06-18
Onset:2021-06-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

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

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

Write-up: Fever, headache, body aches


VAERS ID: 1412741 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitim D, Melatonin, Magnesium, Vitamin B2, Benadryl.
Current Illness: N/a
Preexisting Conditions: Anxiety
Allergies: Sefzil
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: After receiving vaccine patient experienced a fainting feeling from anxiety.


VAERS ID: 1412751 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-21
Onset:2021-06-19
   Days after vaccination:59
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN8729 / 2 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Dehydration, Motion sickness, Nausea, Rash, Skin exfoliation, Vomiting
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (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: No
Current Illness: No
Preexisting Conditions:
Allergies: Fragrance MSG Gluten chicken
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash on top of hands within 1 hour Peeling skin on the back of wrists within 2 hours, rash is still there Rash around neck, back of ears and the side of neck Threw up 9 times one day and was severely dehydrated, had motion sickness and could not keep water down. A nurse had suggested IV to stay hydrated but a herbalist suggested homeopathic medicine for nausea and motion sickness instead


VAERS ID: 1412781 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-18
Onset:2021-06-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

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

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

Write-up: Fever starting at 9am the day following injection


VAERS ID: 1412789 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-17
Onset:2021-06-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Congenital cataracts
Allergies: Only Pollen as far as I know.
Diagnostic Lab Data:
CDC Split Type:

Write-up: I woke up today on 06/19/2021 with itchy, swollen, and stinging lips.


VAERS ID: 1412790 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-12
Onset:2021-06-19
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / SYR

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Nausea, SARS-CoV-2 test
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), COVID-19 (broad)

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

Write-up: extreme fatigue and nausea


VAERS ID: 1412792 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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

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

Write-up: FAINTED, SEIZURE LIKE SYMPTOMS


VAERS ID: 1412795 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-06-11
Onset:2021-06-19
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Menstrual disorder
SMQs:

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

Write-up: Got my menstrual cycle 11 days early


VAERS ID: 1412800 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

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

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

Write-up: -Diaphoretic, dizzy. -Brought to medical screening by wheelchair for evaluation. -BP: slightly elevated. -No interventions -Left in stable condition at 10:45 -Recorded by RN Medic:


VAERS ID: 1412802 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: A few minutes after receiving his first moderna vaccine patient experienced chills, dizziness, paleness, and sweats. We had the patient lay down on the floor until he was ready to sit up again. (about 5 minutes). After laying down we had the patient sit and wait in the pharmacy wait for another 10-15 minutes. In total patient was here for about half an hour


VAERS ID: 1412810 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-18
Onset:2021-06-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Loss of consciousness, Syncope, Vomiting
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), 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: Birth control pill
Current Illness: Psorias flare up
Preexisting Conditions: Psoriasis
Allergies: None
Diagnostic Lab Data: N/a
CDC Split Type:

Write-up: Lightheaded, dizziness, then proceeded to faint. I was in a sitting position and my boyfriend said I passed out for 5 seconds. I vomited immediately after regaining consciousness.


VAERS ID: 1412811 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Headache
SMQs:

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

Write-up: Mild headache, started 10 min. after vaccination. Has not eaten or drank anything today. Given water-Seen by Medics. No further interventions. Left in stable condition at 10:34 a.m. Recorded by RN. Medic


VAERS ID: 1412815 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Rash, Rash erythematous, Rash papular
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: otezla prenatal vitamin unisom
Current Illness: psoriasis
Preexisting Conditions: psoriasis
Allergies: not that she is aware of
Diagnostic Lab Data: none yet, patient plans to see dermatologist as soon as she can get an appointment
CDC Split Type:

Write-up: within minutes of injection patient developed rash on chest extending just below collar bone, back of neck to shoulder blades. small red raised rash. not itchy but has persisted for almost three weeks with no change.


VAERS ID: 1412830 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / UNK RA / 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: Patient has a history of angioedema.
Allergies:
Diagnostic Lab Data: Vitals: Pulse: 57 Respiration: 18 SPO2: 100% B/P: 124/92
CDC Split Type:

Write-up: AE: Patient stated felling light headed 5 minutes post vaccine administration. Treatment : Patient was given water to drink and monitored . Symptoms improved after drinking water. Outcome: Patient was discharged to POV/Home.


VAERS ID: 1412839 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Hypoaesthesia, Pain in extremity
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Patient experienced pain and numbness in left arm after administration. Numbness and pain were reported in lower arm extremity. Patient evaluated over the course of 30 minutes. During that course patient reported pain and numbness travelling down to wrist and fingers. She also reported a pounding headache once felt on forhead. Patient did report that it was getting better than worse over the course of observation. Mother was advised to contact pediatrician for further assistance if it progresses to worst.


VAERS ID: 1412843 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

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

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

Write-up: After 1-2 minutes of administering vaccine pt started sweating profusely and was light headed. Advised pt to sit, breathing seemed fine. Had manager call 9-1-1. Pt lost color of skin. Tried checking BP with arm cuff machine, but didn''t work. Had EpiPen on standby while friend call pt parents. Gave bottle of water to pt while talking and observing. EMS arrived and checked BP-normal. Pt left on own accord after resting for 30 minutes.


VAERS ID: 1412863 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: New Hampshire  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821288 / 1 LA / IM

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

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

Write-up: PATIENT FELT DIZZY AND WAS SWEATING. CALLED 911 AND THEY TOOK OVER AFTER APPROXIMATELY 10 MINUTES


VAERS ID: 1412865 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Consciousness fluctuating, Eye movement disorder, Hyperhidrosis, Hypotension, Mydriasis, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Ocular motility disorders (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data: Paramedics checked her blood pressure and it was low. 99/66 mmhg.
CDC Split Type:

Write-up: The patient fainted upon exiting the vaccine room and sitting back in her observation chair approximately two minutes after the vaccine was given. She was in and out of consciousness for about 10 minutes total, was sweating heavily, and eyes dilated and unable to track. We applied a cold compress and ice packs, and then laid patient down flat. Upon laying her down she quickly came back to consciousness and then the paramedics arrived. Paramedics recommended patient go to the hospital for fluids, but patient felt like she was okay. She went out to the ambulance for further observation and testing.


VAERS ID: 1412871 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 2 LA / ID

Administered by: Pharmacy       Purchased by: ?
Symptoms: Disorientation, Dizziness, Fall, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: A few minutes into observation period after the shot, the patient came to the counter, said he felt faint, then collapsed onto the floor. He was disoriented but still breathing and conscious. He was moved into a seated position in a chair, where he proceeded to collapse out of the chair again. An ambulance was called, the EMT staff noted all of his vitals were normal and he stated he felt fine again after they had checked him out.


VAERS ID: 1412876 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Syncope, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT WAS NERVOUS ABOUT VACCINE, HE INQUIRED ABOUT USING A NUMBING AGENT BUT WE DIDNT HAVE ANY THAT WE PROVIDED SO HE PROCEEDED WITH GETTING THE VACCINE. AFTER THE VACCINATION HE WAS OK, WAS TALKING AND WALKING FINE. I INFORMED HIS MOM AND HIM ABOUT WAITING AROUND FOR 15 MINUTES AND THEY WENT TO THE FRONT OF THE STORE WHERE HE SUBSEQUENTLY FAINTED. 911 WAS CALLED, PHARMACIST WENT TO PROVIDE SUPPORT BUT PATIENT WAS NOW CONSCIOUS, REACTIVE, AND SPEAKING. HE BEGAN TO TREMBLE AS THE PARAMEDICS SHOWED UP AND WAS CHECKED OUT BY THE PARAMEDICS. THE MOM LATER CAME BACK TO THE PHARMACY TO BUY TYLENOL AND LET US KNOW HE WAS FINE.


VAERS ID: 1412888 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-18
Onset:2021-06-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

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

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

Write-up: Fatigue, fever, chills, mild body ache


VAERS ID: 1412889 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)

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

Write-up: The patient stated that she felt a tingling sensation down her arm. The clinical staff attended to her. They took her vitals. She was cleared by the staff. (SPo2 97, Pulse 81, resp 19, B/P 123/97).


VAERS ID: 1412893 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

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

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

Write-up: Paleness, syncope, lightheadedness, fainting/passing out, low blood pressure. Refused ambulance help and ER. Blood pressure fell to 88/59 initially then after 30 minutes and drinking some vitamin water and fanning patient''s blood pressure recover to over 100/69 and regain some complexion on her face. She waited additional 30 minutes before she said she was back to normal


VAERS ID: 1412896 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / SYR

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

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

Write-up: Patient experienced dizziness. Blood pressure was taken, it was 120/70, oxygen 99%, heart rate 82. Patient felt better and was observed for an additional 15 minutes before leaving.


VAERS ID: 1412901 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Dizziness, Hyperhidrosis, Presyncope, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient had a near syncopal event approximately 5 minutes after getting the vaccine. He became shaky, weak, diaphoretic and felt like passing out. He was placed on the exam table and approximately 5 minutes later, he was feeling much better and was able to walk out of the clinic feeling like normal.


VAERS ID: 1412905 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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

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

Write-up: PATIENT STARTED TO SLUMP OVER AFTER INJECTION, DID NOT PASS OUT BUT DID LAY ON THE GROUND WITH HER FAMILY AROUND HER. WE GAVE HER WATER AND MOM FANNED PATIENT. AFTER PATIENT LAYED ON THE FLOOR FOR AWHILE, SHE FELT BETTER. DID LEARN THAT PATIENT DIDN''T EAT ANYTHING THIS MORNING AND WAS QUITE APPREHENSIVE ABOUT THE VACCINATION. PATIENT LATER LEFT WITH FAMILY AND WAS FEELING MUCH BETTER


VAERS ID: 1412908 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-17
Onset:2021-06-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Livedo reticularis
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: Generic Adderall prescription, loestrin24
Current Illness: N/a
Preexisting Conditions: N/a
Allergies: N/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: Livedo reticularis developing 2 days post-vaccine on both arms and both legs.


VAERS ID: 1412910 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect dose administered, Product preparation 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: No
Preexisting Conditions: No
Allergies: Unknown
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pt was given about 2.6 doses of the vaccine. The vaccine was reconstituted incorrectly with only 0.8ml of saline. Pt was still given 0.3ml injection, so we calculated she got 2.6 doses for her 2nd dose. Pt was counseled to watch for flu like symptoms for the next few days and to take tylenol or advil to prevent these symptoms. Also told her to stay hydrated. We will monitor her over the next few days. When we spoke with her about an hour after her dose, she was feeling fine.


VAERS ID: 1412918 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-18
Onset:2021-06-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dysgeusia, Paraesthesia oral, Taste disorder
SMQs:, Taste and smell disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LISINOPRIL, METFORMIN, VASCEPA, VITAMIN D3, FAMOTIDINE, MONTELUKAST, LORATIDINE
Current Illness:
Preexisting Conditions: MAST CELL ACTIVATION SYNDROME, HYPERLIPIDEMIA, HYPERTENSION
Allergies: ALCOHOL, MUSHROOMS
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dysgeusia -- first attempted to start eating around 10 AM today. Noticed that my tongue feels like I burned it on hot food (which I didn''t), and my taste is altered with the foods I''m eating this morning.


VAERS ID: 1412921 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Additional Details: Patient fainted after vaccine was given. Ambulance was called. Patient was taken to Hospital. I spoke to mom, after patient was seen at hospital. Hospital believes fainting occured due to patient having low blood sugar.


VAERS ID: 1412923 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 2 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Malaise, Syncope, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received 2nd COVID immunization. Approximately 10 minutes after receiving vaccine she stated she didn''t feel well. She the passed out and started shaking. We laid her down on her left side and she came to in about 20 seconds. EMS was contacted. Ambulance stated her blood pressure was 100/60. She went to hospital with ambulance following her.


VAERS ID: 1412925 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 RA / IM

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

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

Write-up: Site: Itching at Injection Site-Mild, Systemic: Allergic: Itch (specify: facial area, extremeties)-Mild, Systemic: Allergic: Itch Generalized-Mild


VAERS ID: 1412928 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Dizziness, Fatigue, Head injury, Headache, Injection site pain, Lethargy, Muscle rigidity, Nausea, Pain, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Site: Pain at Injection Site-Medium, Systemic: Body Aches Generalized-Medium, Systemic: Confusion-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Exhaustion / Lethargy-Medium, Systemic: Fainting / Unresponsive-Severe, Systemic: Headache-Severe, Systemic: Nausea-Mild, Systemic: Seizure-Medium, Additional Details: PATIENT BECAME STIFF AND SLUMPED OVER IN CHAIR APPROXIMATELY 2 MINUTES AFTER RECEVING VACCINE. HIT HEAD ON WALL. WAS INITIALLY UNRESPONSIVE BUT REGAINED CONCIOUSNESS. DIALED EMERGENCY NUMBER AND RPH STAYED WITH PATIENT. MONITORED VITALS, KEPT PATIENT STILL, PROVIDED A COOL COMPRESS, KEPT PATIENT ALERT. PATIENT WAS CONFUSED AND DISORIENTED. COULD NOT RECALL ALL EVENTS FROM MORNING. EMS ARRIVED AND TRANSPORTED PATIENT TO HOSPITAL.


VAERS ID: 1412933 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-18
Onset:2021-06-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Chest pain, Neck pain
SMQs:, Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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: Iron but temporarily stopped due to recent surgery about 2 weeks ago. Multivitamin. Cipro therapy for 1 week duration, but been off for 5 days before vaccination.
Current Illness: Anemia, DNC and uterine ablation surgery completed on 6/4
Preexisting Conditions: Anemia, inflammatory arthritis
Allergies: tetracyclines, macrodantin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chest pain radiating to back and neck. Comes and goes after a few minutes.


VAERS ID: 1412935 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure increased, Cold sweat, Feeling of body temperature change, Heart rate increased, Hyperhidrosis, Pallor, Presyncope
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypertension (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Advil, Prozac, Propranolol
Current Illness: High blood pressure, gallstones
Preexisting Conditions:
Allergies: Latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Elevated blood pressure and pulse. Sweaty and clammy. Pale. Almost passed out. Hot and cold at the same time. EMS checked patient out and cleared her to go home.


VAERS ID: 1412943 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anxiety, Nervousness
SMQs:, 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: History of anxiety.
Preexisting Conditions: Anxiety
Allergies: none
Diagnostic Lab Data: First vitals were taken at 1:13, heart rate 77, resp 16, BP 159/86, OX SAT 98%. Second vitals were taken at 1:19, heart rate 80, resp 16, BP 153/90, OX SAT 98% June 19th 2021
CDC Split Type:

Write-up: Patient was anxious and nervous. Vitals were taken every 5 minutes.


VAERS ID: 1412953 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Malaise
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: Medications for hypertension, pills for heart, bleedings meds, and Amolppine.
Current Illness: Hypertension
Preexisting Conditions: Hypertension
Allergies: Penicillin
Diagnostic Lab Data: June 19th 2021 First set of vitals at 12:57pm Heart rate 73, resp 18, BP 129/78, OX SAT 96 Second set of vitals at 1:22 Heart rate 76, resp 18, BP 175/100, OX SAT 95 After 2nd vitals were given patient stated that she was feeling better so she left.
CDC Split Type:

Write-up: Patient stated she was not feeling well.


VAERS ID: 1412960 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 1 LA / IM

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

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

Write-up: The patient stated that she felt weak/ fatigued. The clinical staff attended to her. They took her vitals. She stated that she felt better. She was cleared by the staff. (SP02 ? 99, Pulse ? 91 , Resp 18 B/P 123/89 mmhg).


VAERS ID: 1412961 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

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

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

Write-up: Patient was given doe1 of the Pfizer COVID-19 vaccination. Shortly upon standing, the patient experienced an episode of syncope and fell to the floor hitting his head on the counter. The staff immediately called 911 and the pharmacist provided supportive measures until First responders arrived. First responders examined the patient and cleared him to go home with his parents.


VAERS ID: 1412965 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-18
Onset:2021-06-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Electrocardiogram, Fatigue, Hypoacusis, Injection site pain, Pallor, Presyncope, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data: Oxygen saturation 96% on room air from own personal pulse oximetry. ECG 85 beats per minute, normal sinus rhythm from personal ECG device with app
CDC Split Type:

Write-up: Shortness of breath, near syncope, decreased hearing, fever 101.7 degrees F, fatigue, imbalance in standing but dizziness, soreness to right upper extremity( injection site), pallor lips and face Denies palpitation, nausea, headache.


VAERS ID: 1412974 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Flushing, General physical condition abnormal, Hyperhidrosis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Patients wife states that patient fell over in chair approximately 3 minutes after receiving second dose of the COVID Moderna vaccine. Patient got sat back up. Pt had flushing, diaphorhesis, and light headedness. O2 was 95-98, BP 138/87, and HR at 58. EMS showed up within 15 minutes and agreed that vitals were WNL. Patient refused to go to hospital and insisted on going home. Patient left the pharmacy at 3:26 pm.


VAERS ID: 1412978 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back injury, Dizziness, Fall, Neck injury
SMQs:, Anticholinergic syndrome (broad), Accidents and injuries (narrow), Vestibular disorders (broad)

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

Write-up: DIZZINESS AND FALL; SCRAPED NECK AND BACK ON SHELF; TREATED WITH ANTIBIOTICS AND BANDAGES; PATIENT CLAIMED TO BE ALRIGHT AND WAS ABLE TO LEAVE AND MAKE IT HOME SAFELY.


VAERS ID: 1412979 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Dermal filler injection, Lip swelling, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Swelling of lips and face, no airway compromise. IM Epinephrine, swelling decreased. Pt stated similar reaction to flu shot. Patient did not disclose previous allergic reaction in vaccine questionnaire or verbally. Pt stated lip and botox injection sites were areas of swelling.


VAERS ID: 1412982 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 - / IM

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

Write-up: Patient was inadvertently given Pfizer for second COVID vaccine instead of Moderna, as would have been indicated because her initial vaccine was with Moderna. No negative reaction otherwise. Patient safety report filed at our own institution given the error.


VAERS ID: 1412990 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-18
Onset:2021-06-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Diarrhoea, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (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: Fever, diarrhea


VAERS ID: 1412992 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / IM

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

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

Write-up: Patient received the COVID vaccine (Janssen, lot #205A21A use by 08/07/2021) at 1101. Pharmacist vaccinated the client at 1101 and as she was talking to him after administering the vaccine, the client began to slouch to the side in the chair. The client''s eyes were closed when RN ran to station and EMT both assisted the client to the ground. The client loss consciousness for approximately 20 seconds and had no head trauma. The client''s legs were elevated immediately by being place on a chair after he was placed supine on the floor. and his face mask was removed. The client regained consciousness at 1102 and was A & O x 4. The client was pale and denied shortness of breath, difficulty breathing, chest pain, dizziness, or difficulty swallowing. EMT took vitals at 110 BP: 115/75, HR: 46, RR:20, oxygen saturation: 98%, the client''s color returned, skin was pink and warm. Client stated," I feel like I just took a nap, I feel good." The client reported nearly fainting in the past with getting his tattoo and fainting with the removal of stitches. The client was given Gatorade and was offered Pringles, the client denied the Pringles but did have a few sips of Gatorade. The client did not eat breakfast prior to being vaccinated. Denied having any known drug allergies, currently taking any medications, or having any chronic medical conditions. The client was placed in a supine position and then slowly placed in a sitting upright position. Denied any lightheadedness, dizziness, changes in vision, chest pain, or shortness of breath. EMT took vital signs at 1108, HR- 122/82, HR-54, RR-18, oxygen saturation- 99%. The patient then ambulated to the anti-gravity chair with assistance, by EMT and PM. The client placed his face mask back on and was offered a granola bar. The client stated," I''m tracking my macros and I need to check my app." The client then at the granola bar. EMT took vitals at 1113, BP- 122/80, HR-57, RR-18, oxygen saturation-97%. The client denied any oral trauma, head trauma, or incontinence. A final set of vitals were taken at 1121 EMT BP-120/80, HR-54, RR-16, oxygen saturation: 98%, the client stated, " My heart rate is usually in the 40''s, I play Rugby." RN advised the client to follow-up with his primary care provider and educated the client about agency and emergency room precautions. The client was advised by RN to have his friend drive him home, him and his friend verbalized understanding. The client''s friend was observed in the observation area after receiving COVID vaccine. The client left the site at 1202 with his friend, and had a steady and even gait.


VAERS ID: 1412994 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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? 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: None
CDC Split Type:

Write-up: Within seconds after injection, the patient began to slump over and was unresponsive for approximately 5 seconds. His dad and I were asking if he was ok and then he became responsive and said he was fine but had no memory of what just happened. He was completely normal after that except for not remembering what had happened. His father said he was going to take him to the hospital to get him checked out just in case.


VAERS ID: 1413002 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 RA / IM

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

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

Write-up: patient received moderna for first shot, but ended up receiving pfizer for 2nd shot.


VAERS ID: 1413015 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pruritus, Injection site rash
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)

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

Write-up: Patient had itchiness, rash and redness in the arm in 3 places in the arm that she received the vaccine. Shot was given 11:55am, itchiness started at 12:10pm, admininstered #2 25mg capsules at 12:15pm, checked on pt at 12:23pm symptoms not worsening, 12:30pm still itchy, but getting better, 12:45pm no itchiness, redness was gone, no breathing issues through out whole time


VAERS ID: 1413018 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

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

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

Write-up: Vasovagal Syncope


VAERS ID: 1413028 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 RA / IM

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

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

Write-up: Patient got Moderna as first dose but claimed he got Pfizer and was given Pfizer


VAERS ID: 1413032 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

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

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

Write-up: 1325 Pt lost consciousness and feel to the floor from a sitting position. Per reports, pt hit his head on the floor. EMS team activated. POD Director at pt side along with NP. 1326 911 called and emergency services activated 1327 Pt is not A/O x4 and answering all questions appropriately. 1340 Fire dept arrived. Pt sat up and being transferred to fire care 1341 Patient placed in a sitting position, A/Ox4 and swering all questions appropriately Vitals 1326 HR 50, RR 16, Sat 93% 1328 HR 85, RR 16, Sat 98%, BP 139/83 laying position 1331 Glucose 90 1338 HR 89, RR 16, Sat 99%, 1341 HR 69, RR 16, Sat 98%, BP 140/87 Sitting position 1343 BP 136/83


VAERS ID: 1413033 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling hot, 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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received vaccination and shortly after patient started to feel dizzy. Patient then fainted for about 30 seconds then regained conciousness. Patient reported to feel hot after waking up. Otherwise back to normal.


VAERS ID: 1413035 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

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

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

Write-up: Patient has a history of Vasovagal Syncope and felt like he was about to pass out but felt better after lying down immediately.


VAERS ID: 1413037 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Sudden hearing loss, Tinnitus
SMQs:, Hearing impairment (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: None
Preexisting Conditions: None
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sudden hearing loss, tinnitus


VAERS ID: 1413038 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 UN / IM

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

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

Write-up: 19yo Male client had a seizure witnessed by observation nurse after receiving Janssen vaccine. Seizure lasted 4-5 seconds. Client alert and oriented post seizure and reported dizziness. BP 90/64 then 110/78 Client reported not eating for over 24hrs No EMS called Client ambulatory with family upon leave


VAERS ID: 1413040 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

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

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

Write-up: Patient has a history of Vasovagal Syncope which was unknown at time of vaccination. Patient felt like he was passing out, he lied down immediately and started to feel better.


VAERS ID: 1413043 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 UN / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure measurement, 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: none reported
Current Illness: history of syncope with vaccinations
Preexisting Conditions: none reported
Allergies: none reported
Diagnostic Lab Data: blood pressure
CDC Split Type:

Write-up: 30yo Male client reported dizziness and had a syncopal episode after receiving Janssen vaccine. LOC returned without assist. Client alert and oriented post syncope. BP 100/60 Client reported not eating for over 12hrs Gatorade given to client No EMS called Client ambulatory upon leave


VAERS ID: 1413047 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure decreased, Feeling hot, Hyperhidrosis, Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: PATIENT FAINTED SOON AFTER VACCINE. PATIENT WAS HOT AND SWEATY AND NAUSEAOUS. PATIENT'' S BLOOD PRESSURE DROPPED


VAERS ID: 1413049 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 OT / IM

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

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

Write-up: dizziness, chest tightness, pressure. Evaluated by EMS-Refusal to transport.


VAERS ID: 1413054 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / IM

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

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

Write-up: After receiving her 2nd dose she was feeling dizzy, ears clogged and had blurred vision for a few minutes while was in the post vaccine waiting area. After a few minutes, she started feeling better and left the pharmacy.


VAERS ID: 1413057 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-18
Onset:2021-06-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Naproxen 500mg, and Methocarbamol 500mg
Current Illness: Low back pain (recent injury)
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen lemonade at left underarm, about the size of a lime.


VAERS ID: 1413058 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / N/A LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Hyperhidrosis, Hypotension, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), 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: No known medications
Current Illness: No reported illnesses.
Preexisting Conditions: No reported health conditions.
Allergies: No Known allergies.
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Fainted, diaphoretic. Hypotension.


VAERS ID: 1413063 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 2 LA / IM

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

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

Write-up: Patient was administered his 2nd dose of Moderna vaccine. Patient was instructed to wait in the store for 15 minutes after the shot. Patient was sitting in a chair in the designated waiting area and decided to look at the vitamins. Next thing I knew, patient fainted and hit the floor. Patient was taken back to the chair where he was sitting and instructed to wait another 20 minutes. I watched the patient very closely. Patient was given water and OJ. Pt told me that he put nicotine gum in his mouth a minute before I injected him.


VAERS ID: 1413067 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Refusal of treatment by patient
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: Anti-hypertensive medication metformin
Current Illness: None
Preexisting Conditions: Hypertension, Diabetes Mellitus Type II, Seizures
Allergies: NKDA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient (DOB 03-10-1987)received the 2nd COVID vaccine (Pfizer, lot # EW0187 use by 07/15/21) at 1322 in the left arm by LVN. The client was vaccinated in the anti-gravity chair, checked on the client at 1330 and she stated, " I''m feeling a little dizzy." EMT immediately placed the client in a semi-Fowler''s position and RN was notified. RN assessed the client who was A & O x 4 and offered her Benadryl, the client declined Benadryl. while vital signs were taken by EMT BP- 142/86, HR-87, RR- 12, oxygen saturation- 98%. The client denied any headache, lightheadedness, chest pain, difficulty breathing, or swallowing. The client last ate about an hour and a half ago, and was offered Gatorade or water, but declined both. The client had no known drug allergies, had type II diabetes mellitus, hypertension, and history of seizures. Reported currently taking Metformin and an anti-hypertensive medication. The clients vital signs were taken at 1336, BP- 140/86, HR-76, RR-12, oxygen saturation at 98%. RN advised the client to stay for an additional 30 minutes from the start of her feeling dizzy. EMT took vital signs at 1341, BP- 138/86, HR-80, RR-12, oxygen saturation- 98%, the client stated, " The dizziness is gone." The client denied shortness of breath, chest pain, difficulty swallowing, difficulty breathing, or lightheadedness. RN educated the patient to follow-up with her primary care provider if the dizziness returns or worsens and also educated the client about V-safe and emergency room precautions. The client left AMA, prior to the 30 minutes advised, at 1345 and had an even and steady gait when ambulating to her car.


VAERS ID: 1413072 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821287 / UNK RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Influenza & Pneumococcal - unknown name brand, age, dates.
Other Medications: Triamcinolone oint 0.1% , Butal/APAP/CF 50-325-40, Potassium Chloride ER 20meq, Furosemide 20mg, Bupropion ER/SR 100mg, Fexofenadine 60mg, Jardiance 10mg, Aripiprazole 15mg, Gabapentin 800mg, Lamotrigine 200mg, Lisinopril 20mg, Amlodipine 5
Current Illness: NA
Preexisting Conditions: DM, migraines, depression, seasonal allergies, HTN, high cholesterol
Allergies: Lithium, ASA, Cephalexin, Ergot, Flu & Pneumonia shot
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient starting having itching 15 minutes post vaccination, patient forewarned that this would happen as she has had this reaction with the flu shot and pneumonia shot. Patient had already discussed with doctor and he still recommended getting the COVID vaccine. Benadryl 50mg STAT was administered and patient waited another 15 minutes. She was feeling well other than the itching. Recommended that famotidine could also be administered to help with itching, and hydrocortisone cream if a particular spot was more bothersome than others.


VAERS ID: 1413082 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Cold sweat, Loss of consciousness, Malaise, Nasopharyngitis, Pallor, Visual impairment
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal 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: no
Preexisting Conditions: none
Allergies: eggs
Diagnostic Lab Data:
CDC Split Type:

Write-up: 14 yo female was anxious prior to and during vaccination given at 11:59am. The patient was told to sit for 30 mins due to an egg allergy. After waiting 30 minutes, the mother (who was shopping) retrieved child who was sitting in the pharmacy waiting area post vaccination. After 5 more mins, another customer got the RPH attention explaining the patient was passing out. The mother assisted patient to the pharmacy waiting area, in which the patient was given chairs to sit on and put feet up. Another shopper who said she was an ER nurse told the pharmacy staff to have the patient lay down across the chairs then left. The patient was weak, cold, clammy, and pale. The patient then told the pharmacist that she had left her mother at the check out section, went upstairs, used the bathroom, was coming down the stairs when her vision started to have black spots. She reached her mother when she said she didn''t feel good and started to pass out. The mother stated she caught her daughter. At this point, the RPH initiated a 911 call. She called out for the technician to call the store managers for assistance and take over the 911 call. The RPh then stayed with the patient and the mother. The tech gave the mother a bottle of water for the pt. The store managers arrived at the scene and also assisted. The patient stated she was feeling a lot better after she laid down for a little bit. The RPh notice color coming back into the patient''s lips and face. The patient stated that the adverse effects didn''t start until she was walking down the stairs. After 10-15 mins, the Paramedics arrived and further assisted the patient and her mother. The paramedics took the patient via stretcher to the ambulance for further treatment around 12:55pm.


VAERS ID: 1413088 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fall, Head injury, Hyperhidrosis, Pallor, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient received the shot, then sat in chair in waiting area. He became dizzy, we believe and fell over. Pharmacist reported he was pale and sweaty. He also vomited, and hit his head. He was transported to the hospital by 911. The pharmacist had him lay and not move and gave him an ice pack for behind his neck while waiting for emergency personnel.


VAERS ID: 1413093 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-06-17
Onset:2021-06-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

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

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

Write-up: Chest pain?left side


VAERS ID: 1413094 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Ear congestion, Hypoacusis
SMQs:, Hearing impairment (narrow)

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

Write-up: Fullness in both ears, reduced hearing beginning one hour after shot.


VAERS ID: 1413095 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Petechiae
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: NP re assessed the patient and made the patient aware of sleepiness may cause, Instructed mom to allow patient to sleep once they arrived home.
CDC Split Type:

Write-up: second Pfizer vaccine vaccine was administered the patient developed a purple petechiae rash started developing on her left hand. NP ordered 25mg of Benadryl to be administered PO for the patient and to stay in observation for the next 30 min. The 30 min were observed by the LVN the patient''s rash was clear and patients vitals are as fallowed B/P 116/67 Resp 18 O2 94. The patient said she was feeling well no sighs of SOB .


VAERS ID: 1413099 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-06-18
Onset:2021-06-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 - / SYR

Administered by: Other       Purchased by: ?
Symptoms: Hallucination, Headache, Hypersomnia
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (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: Vitamin C and Multi Vitamin
Current Illness: Hours after 2nd vaccination my son experienced hallucinations and bad headaches that took more than one dose of Tylenol to get rid of.
Preexisting Conditions: Asthmatic
Allergies:
Diagnostic Lab Data: 2nd covid dose
CDC Split Type:

Write-up: My son experienced hallucinations several hours after 2nd dose. He also experienced really bad headaches that required more than one dosage of Tylenol. Slept for 10hrs after last dose.


VAERS ID: 1413105 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-06-03
Onset:2021-06-19
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Headache
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: n/a
Current Illness: none
Preexisting Conditions: none
Allergies: unknown
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: A slightly sharper headache in the early morning around 2:00 A.M. Not unusual for me to wake up early as I am an early riser as is. Took Tylenol Acetaminophen for remedy. Usually I am up early in the morning but was a little more unusually was able to fall back to sleep with some headache awakening before waking up at a (for me) relatively late 6:30 A.M. It''s about 6 P.M. 6/19/21, and unlike other headaches that may have been from just maybe not drinking enough water during a work day, I felt a couple little pings of a headache.


VAERS ID: 1413106 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, Muscle twitching, Musculoskeletal stiffness
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), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Arthritis (broad), Hypoglycaemia (broad)

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

Write-up: Patient started to be unconscious and not alert 5-10 minutes after vaccination. Patient was twitching, clenched hands, stiffness of muscles for <1 minutes. 911 was called but patient denied ems assistance.


VAERS ID: 1413107 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 609D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Nasal congestion, 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: none
Preexisting Conditions: none
Allergies: unknown
Diagnostic Lab Data: none
CDC Split Type:

Write-up: patient experienced nausea and stuffy nose a few minutes after vaccine administration


VAERS ID: 1413109 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient fainted about a minute after getting the shot. he felt dizzy, no other symptoms.


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