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

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



Case Details (Reverse Sorted by Onset Date)

This is page 96 out of 5,069

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VAERS ID: 1493161 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Michigan  
Vaccinated:0000-00-00
Onset:2021-06-25
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Alopecia, Apnoea test, Chills, Fatigue, Headache, Maternal exposure during pregnancy, Oropharyngeal pain, Pharyngitis streptococcal, Pyrexia, Sleep apnoea syndrome, Suspected COVID-19, Tonsillitis, Vomiting
SMQs:, Acute pancreatitis (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: FOLIC ACID
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Autism; Functional neurological symptom disorder (Functional Neurological Disorder with clink rare genes with child); GERD; Tonsillitis
Allergies:
Diagnostic Lab Data: Test Name: sleep apnea; Result Unstructured Data: Test Result:unknown results
CDC Split Type: USPFIZER INC2021849351

Write-up: she was fighting tonsil infection or strep from what doctors assume; she was fighting tonsil infection or strep from what doctors assume; hair started to fall out; had every type of COVID symptom; vomiting; fevers; chills; sore throat; tiredness; headache; sleep apnea; pregnant at time of vaccination/ gestation period were 31 weeks; This is a spontaneous report from a contactable consumer. This consumer (patient) reported that a 27-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) at the age of 27-years, via unspecified route of administration at single dose for COVID-19 immunization, first dose in left arm on 25Jun2021 at 12:00 and second dose on unspecified date. Medical history included tonsillitis, functional neurological disorder with clink rare genes with child, GERD, autism. The patient was pregnant at time of vaccination. Patient last menstrual period date was 10Dec2020 and pregnancy due date 09Sep2021, gestation period were 31 weeks. No other vaccine in four weeks. No known allergies. No COVID-19 prior vaccination. Concomitant medications included prenatal (unspecified), folic acid, antibiotics. The patient reported that after her first and second dose her hair started to fall out. She was fighting tonsil infection or strep from what doctors assume. She probably should of waited until she was done taking her penicillin anti biotic. She had every type of COVID symptom but doctor was surprised to find no illnesses to explain her vomiting, fevers, chills, sore throat, tiredness, headache, etc. She saw a tonsil doctor to set up future removal. And sleep apnea testing. Adverse event start date on 20Jun2021 (as reported). Adverse event resulted in doctor or other healthcare professional office/clinic visit. No treatment received. No COVID-19 tested post vaccination. Outcome of the events was not recovered. Information about batch/lot number has been requested.


VAERS ID: 1493600 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-24
Onset:2021-06-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Gingival blister, Tenderness
SMQs:, Gingival disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: St. John''s Wort tincture, multi-vitamin
Current Illness:
Preexisting Conditions: psoriasis
Allergies: PCN - rash
Diagnostic Lab Data:
CDC Split Type:

Write-up: Two mouth blisters on gums - pea-sized raised, very tender.


VAERS ID: 1493955 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-15
Onset:2021-06-25
   Days after vaccination:71
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Cough, Nasopharyngitis, Oropharyngeal pain, Respiratory tract congestion, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), COVID-19 (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: Zyrtec
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Covid test - negative
CDC Split Type:

Write-up: Regular viral cold - congestion, coughing, sore throat. Covid test negative, doctor informed me a normal summer cold/flu was going around. OTC treatment.


VAERS ID: 1494087 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-13
Onset:2021-06-25
   Days after vaccination:73
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain lower, Blood test abnormal, Computerised tomogram abdomen abnormal, Cyst drainage, Fatigue, Hepatic steatosis, Immediate post-injection reaction, Lymphadenopathy, Presyncope, Pyrexia, Sleep disorder, Vaginal cyst, Vomiting
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None.
Current Illness: None.
Preexisting Conditions: Lymph Node Enlargement (since June 26, 2021)
Allergies: None.
Diagnostic Lab Data: CT Upper and Lower Body/ Appendix, Full Panel Blood Work, Cyst drainage
CDC Split Type: vsafe

Write-up: I had mild symptoms on first day including fever and fatigue--it happened right after vaccine but I felt fine. Recently on June 24, 2021 I got this blinding pain in the middle of the night around 12/12:30 AM and it was excruciating that I almost passed out --it was in my lower abdomen. What came with the pain was vomiting and I threw up 4-5 times. It was coming and going and it felt almost like a contraction. It felt like I was in labor. It lasted several hours until 2/3 AM when I started feeling better and slept. The next day I went to urgent care at Kaiser Fontana Medical Center and they did CT and some blood work and the tests came back abnormal for fatty liver. They also wouldn''t tell me the cause of my pain because there wasn''t anything on CT that showed anything. Everything else was OK except for the enlargement on lymph node on left side and a cyst in vagina that was drained on Monday 07/19/2021. I had a small procedure on Monday. The cyst could have been there before vaccine. Only thing I''m concerned about is lymph node enlargement and they will do pelvic exam u/s soon and ill see a specialist for lymph nodes. All of these started June 25 and still ongoing.


VAERS ID: 1494102 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal distension, Aphasia, Asthenia, Back pain, Blood test normal, Condition aggravated, Disturbance in attention, Dysarthria, Fatigue, Feeling abnormal, Fluid retention, Headache, Hypoaesthesia, Magnetic resonance imaging head normal, Malaise, Nausea, Neck pain, Peripheral swelling, Poor peripheral circulation, SARS-CoV-2 test, Swelling face, Vision blurred
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (narrow), Arthritis (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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D, Vitamin C, Baclofen, Trazodone, Tizanidine, Wellbutrin, Levothyroxine, lidocaine cream and patches
Current Illness: none
Preexisting Conditions: migraines, chronic pain, arthritis, poor blood circulation,
Allergies: none
Diagnostic Lab Data: blood test MRI Covid test
CDC Split Type: vsafe

Write-up: After 1 got the 1 st dose vaccine, a few hours later around 1pm, I was having blurred vision. I felt very tired, nausea and exhausted and I went home and went to bed. I did take some Tylenol to help relieve my symptoms. I also had left leg swelling, my face was puffy and I was just not feeling good. I had problems focusing, brain fog, complete fatigued, absolutely no energy and completely worn out. I have issues with blood circulation on the left side of my body and I had fluid rentention on my torso and my face. The swelling lasted for 10 days. I still have some swelling but not as bad as before. I do wear compression socks to help alleviate the swelling accumlation. I also have right side numbness on my face, foot and back. I also have difficulty talking and expressing words and getting words out. This lasted for 2 weeks. I still have this deficit and it comes and goes. It is not as bad as before. I have neck and back pain and my headaches are very bad. The pain can be measured 8/10. I did go to the ER and did run a bunch of test, labs, MRI- which came back normal. I followed up with my PCP and will be following up with neurology and pain clinic.


VAERS ID: 1494143 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Fatigue, Lymphadenopathy, Malaise, Mammogram, Mobility decreased, Mouth ulceration, Urticaria
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (narrow), Systemic lupus erythematosus (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: tylenol
Current Illness: none
Preexisting Conditions: breast ca, ovarian tumor
Allergies: augmentin, Crestor
Diagnostic Lab Data: mammogram due to the lymphadenopathy
CDC Split Type:

Write-up: fatigued, maliase, weakness for the first hour. unable to get out of bed. Mouth ulcers, hives, urticaria, lymphadenopathy (1 month). lymph nodes are still slightly swollen and tender


VAERS ID: 1495689 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016B21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Exposure during pregnancy, Product administered to patient of inappropriate age
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal vitamins with minerals 28 mg iron-800 mcg tablet Tylenol Extra Strength 500 mg. Iron 325 mg (65 mg iron) tablet.
Current Illness: Anemia related to pregnancy.
Preexisting Conditions: None known.
Allergies: No known allergies.
Diagnostic Lab Data: None applicable.
CDC Split Type:

Write-up: Patient was given Moderna which should not be given to patients under the age of 18. Per CDC guidelines 2nd dose was given on 07/22/2021. patient turns 18 years of age on 08/03/2021.


VAERS ID: 1497225 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 LA / OT

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Irritability, Nausea
SMQs:, Acute pancreatitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (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: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: none
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202100917635

Write-up: Nausea; Fatigue; Irrirability; This is a spontaneous report from a contactable consumer (patient). A 27-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection; lot number: EW0198 and expiration date: not reported), via intramuscular, on upper Left arm, on 25Jun2021 at 09:00 (at the age of 27-year-old), as DOSE 2, SINGLE for covid-19 immunization at pharmacy/drugstore. The patient had no medical history. The patient''s concomitant medications were not reported. Historical vaccine included BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection; lot number:EW0187and expiration date: not reported) via intramuscular, on upper Left arm, on 04Jun2021 at 13:00 (at the age of 27-year-old) as DOSE 1, SINGLE for covid-19 immunization at pharmacy/drugstore and experienced Confusion, Blurry Vision and Dizziness. On 25Jun2021 at 10:30 also reported as 1.5 hrs. after given 2nd dose the patient experienced nausea, fatigue and, irritability which took 36hrs to go away. The outcome of the events was recovered on 26Jun2021 at 22:30.


VAERS ID: 1497420 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-24
Onset:2021-06-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypersensitivity, Inflammation, Lymphadenopathy, Lymphatic disorder, Pruritus, Rash, Rash papular, Swelling face, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: METOPROLOL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Blood pressure high
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021855413

Write-up: Itching; Inflammation of the face with small bumps, painless but itchy; Inflammation of the face with small bumps, painless but itchy/some lumps on his face on his cheeks and under his jaw; Swollen lymph nodes; Rash; Hives; Swelling of the face; acute allergic reaction; lymphopathy; This is a spontaneous report from a contactable consumer (patient). A 69-years-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Injection), dose 1 via an unspecified route of administration, administered in Arm Left on 24Jun2021 18:00 (Batch/Lot Number: EW0196) at age of 69-years-old as single dose for COVID-19 immunization. Medical history included high blood pressure from an unknown date and unknown if ongoing. No known allergy. Concomitant medication included metoprolol received within 2 weeks of vaccination. Patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. Facility the most recent COVID-19 vaccine administered was pharmacy or drug store. The patient experienced swollen lymph nodes, rash, hives and swelling of the face on 25Jun2021 with outcome of unknown, inflammation of the face with small bumps, painless but itchy/some lumps on his face on his cheeks and under his jaw on 25Jun2021 07:00 with outcome of not recovered, itching on 25Jun2021 07:00 with outcome of recovered in 2021, all reported as medically significant. AE resulted in Emergency or urgency room/department. Treatment to against allergy was received. Clinical course reported as follow: Patient received the first shot of the Pfizer Covid-19 vaccine on 24Jun2021 and the next day he had an allergic reaction. He went to withheld Hospital in withheld to the emergency room because his face was swollen and he had some lumps/"bumps" on his face on his cheeks and under his jaw. The treatment he received was diphenhydramine (BENADRYL) 25 mg oral capsules, oral tablets (2 tablets a day for 4 days); Prednisone 20 mg oral tablets, and Hydrocortisone topical 0.1% cream. He had to take 2 tablets of Prednisone 20 mg for 4 days. He took the treatment for 3 days and now has stopped it. He no longer has the itching he previously had. He had internal swelling on the face, like if the swelling was coming from his glands. He currently has no itchiness swelling was internal, like lymph nodes. The diagnosis the doctor gave him was acute allergic reaction (2021) and they described it as itching on the face and swelling. He was due to get his second dose of the COVID-19 vaccine on 15Jul2021. He needed to explain that the swelling on his face was supposed to be on his neck but because of an allergic reaction, he got this on his face. It was called lymphopathy (2021). The lymph nodes were supposed to come out on his neck but nothing came out on his neck, they came out on his face was what the doctor were informed. Prior to vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient has not been tested for COVID-19.


VAERS ID: 1497454 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-06-11
Onset:2021-06-25
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 1 - / -

Administered by: Unknown       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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021862956

Write-up: I am entered in Menopause and I have not had any period for 11 months but I am having Menstrual bleeding after my Covid shot; almost 4 periods it''s really weird; This is a spontaneous report from a contactable consumer or other non-health care professional (patient). A patient of unspecified age and gender received first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, Batch/Lot Number: EW0202) via an unspecified route of administration on 11Jun2021 as dose 1, single for COVID-19 immunization and received second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, Batch/Lot Number: EW0187) unspecified route of administration on 02Jul2021 as dose 2, single for COVID-19 immunization. The patient medical history and concomitant medications were not reported. On 25Jun2021, the patient experienced I am entered in Menopause and I have not had any period for 11 months but I am having Menstrual bleeding after my Covid shot; almost 4 periods it''s really weird. When probed for event start date, consumer stated, 25Jun2021 and then I had Doctor Appointment but not a gynecologist but for regular checkup she told my Doctor that I am entered in Menopause and I have not had any period for 11 months, I met and Gynecologist. I had my second Covid shot and then Sunday I start little worse and then on Monday, Tuesday, Wednesday and today it''s almost 4 periods it''s really weird. When probed for any treatment for the problem, consumer stated, No, what would I take for that. When probed for any laboratory work, consumer stated, I went through my Physical Exam and my regular Doctor had. I went to see her a couple of days after later she had the lab report I had to the lab work she said your chart are text book perfect. The clinical outcome of the event was reported as unknown. Follow-up attempts are needed. Information on Lot/Batch number was available.


VAERS ID: 1497472 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-06-24
Onset:2021-06-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Back pain, Chest pain, Headache, Neck pain, Pain, Pain in extremity, Vaccination site pain
SMQs:, Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021868899

Write-up: Stated that she experienced headaches that were unusual that come and go last few minutes then a sharp pain and go away; Stated that she had sharp pain on the left side of her chest; Pain radiating up her arms and down her arms; Pain in her shoulder blades; Injection site pain to left arm; Pain radiating down to her fingers/ pain radiating up to her neck/ pain radiating down her back/ pain radiating up her arms and down her arms; Pain radiating up to her neck; Pain radiating down her back; This is a spontaneous report from a Pfizer sponsored program. A 56-year-old female consumer (patient) reported for herself that: A 56-years-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Formulation: Solution for injection, Lot number: Unknown), via an unspecified route of administration in the left arm on 24Jun2021 as dose 1, single for COVID-19 immunisation. The patient medical history and concomitant medications were not reported. It was reported that consumer called for reporting adverse reaction after getting first dose of Pfizer COVID vaccine on 24Jun2021. She stated that 24 hours after the first dose that she had pain at the injection site radiating down to her fingers up to her neck and down her back. She experienced headaches that were unusual that come and go last few minutes then a sharp pain and go away. Some days she had headaches some days not a lot. She had sharp pain on the left side of her chest. She spoke to her provider regarding the pain and not related to her heart and other pain she was experiencing. She was told that she was not feeling any pressure and it was not related to her heart. She has headaches every day that come and go. Stated that the headaches were not like normal that it comes for few minutes and then stop. Stated that the pain goes up into her neck and was in her shoulder blades and up her arms and down her arms. She wanted to know if safe to get other one on 15Jul2021. Stated that she went to the doctor "today" about this. She was told to call Pfizer and he would call as well. She wanted to know if this was a normal side effect. Later clarified that it was her left arm for the injection site pain. The outcome of the events was unknown. Information about lot/batch number has been requested.


VAERS ID: 1428019 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-19
Onset:2021-06-25
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA1027 / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Thrombosis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (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: Sertraline
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Heavy menstrual bleeding and increasing clotting


VAERS ID: 1430264 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Cold sweat, Fatigue, Formication, Headache, Myalgia, Nausea, Pain in extremity, Pyrexia, Restless legs syndrome, Restlessness
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: 3 hours after vaccination the pain came on in injected arm. Overnight was gradual onset of fever (37.1 C); restless body and legs; crawling skin sensation; chills. At that time my arm started to ache very bad in the area of biceps, triceps, and lats on the left side. The following morning I got up with a terrible nausea with fatigue. Fatigue magnitude was as such that I got to the washroom, sat on the toilet and could not move for 30 minutes (no energy); all the time feeling cold sweat dripping off my skin. 24 hours after injection severe headache started and lasted for 4 hours then faded away by the bed time. My second night was alright with only moderate pain in the injected arm. 30 hours after vaccination. I am back to almost normal with moderate pain in the arm. But I have never been so sick in my life. ( Continued on page 2 )


VAERS ID: 1430473 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-22
Onset:2021-06-25
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site induration, Injection site pain, Injection site pruritus, Injection site reaction, Injection site warmth, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: A few days after vaccination, a hard red welt appeared on upper left arm 4 inches below where the shot was injected. It is warm and tender to the touch with some itchiness.


VAERS ID: 1443691 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 RA / IM

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

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

Write-up: One of our stores got confused with the storage parameters around the Pfizer vaccine and exceeded the 14 day freezer window. The Vaccine was placed inside the freezer on 6/5/21 and taken out on 6/25/21 and placed into the refrigerator. The store has vaccinated 50 people from 6/25/21 ? 6/29/21. The temperature range for the days the vaccine was in the freezer was -0.9 (warmest) to -5.9 (coldest) with an avg temp of -4.9


VAERS ID: 1457102 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-25
Onset:2021-06-25
   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 EX0575 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arrhythmia, Arthralgia, Chest pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Arthritis (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: No
Current Illness: NO
Preexisting Conditions: NO
Allergies: NUT
Diagnostic Lab Data:
CDC Split Type:

Write-up: SKIN ALLERGY CHEST PAIN FEVER JOINT PAIN ARRHYTHMIA


VAERS ID: 1465398 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD5613 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Headache, Myalgia, SARS-CoV-2 test
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (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: GEDAREL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Contraception
Allergies:
Diagnostic Lab Data: Test Name: COVID-19 virus test; Test Result: Negative ; Comments: No-Negative COVID-19 test
CDC Split Type: GBPFIZER INC2021797751

Write-up: Tiredness; Headache; Muscle pain; This is a solicited report from a contactable consumer. This is a report received from the Regulatory Agency. Regulatory authority report number GB-MHRA-YCVM-202106241114220220-RGEQF, Safety Report Unique Identifier GB-MHRA-ADR 25551709. An 18-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on 25Jun2021 at age of 18-year-old (Lot Number: FD5613) as DOSE NUMBER UNKNOWN, SINGLE for COVID-19 immunisation. Medical history included contraception. Patient last menstrual period date was 11Jun2021. Patient has not had symptoms associated with COVID-19. Patient is not enrolled in clinical trial. Patient is not pregnant. Patient is not currently breastfeeding. Concomitant medication(s) included desogestrel, ethinylestradiol (GEDAREL, Manufacturer unknown) taken for contraception. The patient experienced tiredness on 25Jun2021 with outcome of recovered on 27Jun2021, headache on 25Jun2021 with outcome of recovering, muscle pain on 25Jun2021 with outcome of recovered on 27Jun2021. The events were reported as serious for medically significant. The patient underwent lab tests and procedures which included COVID-19 virus test: negative COVID-19 test on unknown date. The reporter''s assessment of the causal relationship of the events with the suspect product was not provided at the time of this report. Since no determination has been received, the case is managed based on the company causality assessment No follow-up attempts are possible. No further information is expected.; Sender''s Comments: Based on temporal association and known safety profile the reported fatigue, headache and muscle pain are assessed s related to BNT162B2. Case will be reassessed if additional information is received.


VAERS ID: 1468794 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-06-19
Onset:2021-06-25
   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 - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: HUPFIZER INC2021802073

Write-up: myocarditis; This is a spontaneous report from a contactable physician. A 17-year-old male patient received the second dose of BNT162B2 (COMIRNATY), via an unspecified route of administration on 19Jun2021 as DOSE 2, SINGLE for COVID-19 immunisation. The patient''s medical history and concomitant medications were not provided. By 25Jun2021 myocarditis developed, which may correspond to side effects. Outcome of the event was unknown. Information on the lot/batch number has been requested.; Sender''s Comments: A possible contributory role of the suspect drug to the reported event myocarditis cannot be completely excluded based on temporal association. This case will be re-assessed when additional information becomes available. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identifies as part of this review, as well as any appropriate action in response, will be promptly notifies to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.


VAERS ID: 1475141 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-24
Onset:2021-06-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Maternal exposure during pregnancy, SARS-CoV-2 test, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: Pregnancy
Preexisting Conditions: Medical History/Concurrent Conditions: Lactation decreased
Allergies:
Diagnostic Lab Data: Test Name: COVID-19 virus test; Test Result: Negative ; Comments: No - Negative COVID-19 test
CDC Split Type: GBPFIZER INC2021786747

Write-up: Maternal exposure during pregnancy third-trimester (29-40 weeks); Vomiting; This is a spontaneous report from a contactable consumer received from the Regulatory Agency. The regulatory authority report number is GB-MHRA-WEBCOVID-202106251249125840-J01CC, Safety Report Unique Identifier GB-MHRA-ADR 25543552. A 30-year-old female patient received of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) via an unspecified route of administration on 24Jun2021 (lot number and expiry date: unknown) as dose 2, single for COVID-19 immunisation. Medical history included lactation decreased and ongoing pregnancy. Patient has not had symptoms associated with COVID-19. Patient is not enrolled in clinical trial. Concomitant medication included folic acid taken for folic acid supplementation, start and stop date were not reported. The patient previously received first dose of BNT162B2 for COVID-19 immunisation. The patient experienced maternal exposure during pregnancy, third-trimester (29-40 weeks) on an unspecified date, and vomiting on 25Jun2021. Additional information: Patient was exposed to the medicine on third trimester (29-40 weeks). The health authority assessed the events as serious due to other medically important condition. The patient underwent lab tests and procedures which included COVID-19 virus test: no-negative on unspecified date. Outcome of the event vomiting was not recovered. No follow-up attempts are needed, information about lot/batch number cannot be obtained. No further information is expected.


VAERS ID: 1492644 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-17
Onset:2021-06-25
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3098 / 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: NLPFIZER INC2021843536

Write-up: Patient was pregnant still early but 25Jun2021 miscarriage underway; This is a spontaneous report from a contactable consumer downloaded from the regulatory authority-WEB, regulatory authority number NL-LRB-00602837. A 40-year-old female patient received first dose of BNT162B2 (COMIRNATY), via an unspecified route of administration on 17Jun2021 (Lot Number: FC3098) as single dose for covid-19 immunisation. The patient medical history and concomitant medications were not reported. Patient was pregnant still early but 25Jun2021 miscarriage underway. The miscarriage occurred at a pregnancy duration of about 5.5 weeks (1 trimester). This was the first covid vaccination, which took place at a pregnancy duration of about 4 weeks. The patient previous was no COVID-19 infection. The outcome of the event was unknown. Sender Comment: Since the nature of the reported reaction does imply seriousness according to one of the HA critera, the reaction was considered as serious by the regulatory authority. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1493281 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-06-25
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Chills, Fatigue, Gait disturbance, Headache, Injection site reaction, Malaise, Myalgia, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Not known. Non-smoker, no alcohol.
Allergies:
Diagnostic Lab Data:
CDC Split Type: BEJNJFOC20210738077

Write-up: UNSTABLE ON THE LEGS; REACTION AT THE INJECTION SITE; FEELING UNWELL; COLD CHILLS; JOINT PAIN; MUSCLE PAIN; NAUSEA; HEADACHE; FATIGUE; FEVER; This spontaneous report received from a consumer via a Regulatory Authority [EMEA EVHUMAN NLP, BE-FAMHP-DHH-N2021-98991] concerned an 18 year old female. The patient''s weight was 49 kilograms, and height was 166 centimeters. The patient''s pre-existing medical conditions included not known. non-smoker, no alcohol. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 21C14-02 expiry: UNKNOWN) dose was not reported, 1 total administered on 25-JUN-2021 for covid-19 immunisation. No concomitant medications were reported. On 25-JUN-2021, the patient experienced unstable on the legs, reaction at the injection site, feeling unwell, cold chills, joint pain, muscle pain, nausea, headache, fatigue and fever. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from muscle pain, reaction at the injection site, nausea, joint pain, headache, feeling unwell, unstable on the legs, fatigue, cold chills, and fever. This report was serious (Disability Or Permanent Damage).; Reporter''s Comments: Treatment - No Evolution of the ADR - Recovering ADR description - Unstable on the legs, throbbing head, fever, nausea, muscle pain (arm and, neck, legs, lower back...). The time relation (ADR) - Everything started at the same time, after a night of ?sleep'' everything got worse. I suppose these side effects will pass within 1 to 2 days.; Sender''s Comments: V0- 20210738077-Covid-19 vaccine ad26.cov2.S Unstable on the legs, Reaction at the injection site. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s). 20210738077-Covid-19 vaccine ad26.cov2.S- Feeling unwell, Cold chills, Joint pain, Muscle pain, Nausea, Headache, Fatigue, Fever. This event(s) is labeled per RSI and is therefore considered potentially related.


VAERS ID: 1496277 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Headache, Influenza like illness, Maternal exposure timing unspecified, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Pregnancy
Allergies:
Diagnostic Lab Data:
CDC Split Type: GBPFIZER INC2021863357

Write-up: tiredness; headache; Pins and needles; Flu like symptoms; became pregnant while taking bnt162b2; This is a spontaneous report from a contactable consumer or other non hcp received from a regulatory authority. The regulatory authority report number is GB-MHRA-WEBCOVID-202107070021116040-OFIGY. Sender''s (Case) Safety Report Unique Identifier: GB-MHRA-ADR 25608368. A 38-year-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 1 via an unspecified route of administration on 25Jun2021 (Batch/Lot number was not reported) at the age of 38-year-old as single dose for covid-19 immunization. Patient had not had symptoms associated with COVID-19, Not had a COVID-19 test. Patient was not enrolled in clinical trial. Medical history included pregnancy. The patient''s concomitant medications were not reported. The patient experienced tiredness on an unspecified date with outcome of unknown, headache on an unspecified date with outcome of unknown, pins and needles on 25Jun2021 with outcome of recovered on 26Jun2021, flu like symptoms on 25Jun2021 with outcome of recovered on 26Jun2021. The events were serious as medically significant. The patient became pregnant while taking bnt162b2. Patient had 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 possible; information about lot/batch number cannot be obtained. No further information is expected.


VAERS ID: 1496882 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA9090 / 1 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Body temperature increased, Disseminated Bacillus Calmette-Guerin infection, Dizziness, Hypotension, Maternal exposure during pregnancy, Nausea, Pelvic pain, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (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), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (broad), Sepsis (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: MXPFIZER INC2021880657

Write-up: Gestation week: 22; BCGosis; Body Temperature Increased; Nausea; dizziness / feeling faint; pelvic pain; emesis; hypotension; This is a Spontaneous report from a non-contactable Other Health Professional. This is a report received from a regulatory authority via email. Regulatory authority report number is 16638-7. A 29-years-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 1 intramuscular administered in arm left on 25Jun2021 (at age of 29 years old) (Batch/Lot Number: FA9090; Expiration Date: 01Oct2021) as single dose for covid-19 immunisation. The medical history and concomitant medications were not reported. The patient did not have Infectious disease in the last 15 days prior to vaccination. The patient was healthy before vaccination. No allergies. The patient experienced BCGosis, body temperature increased, nausea, dizziness, feeling faint, pelvic pain, emesis and hypotension on 25Jun2021. Timeframe between vaccination and starting of symptoms was 1 minute. The mother reported she became pregnant while taking bnt162b2. The mother was 22 weeks pregnant at the onset of the event. Clinical course as follow: patient who was vaccinated on 25Jun2021 with Pfizer brand, presents at 30 seconds feeling faint, dizziness, at 5 minutes presents pelvic pain, at 15 minutes presents emesis and hypotension. No treatment received before receiving medical attention. The events was unknown. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1497608 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-06-25
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Malaise, Myalgia, Nausea, Pyrexia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? Yes
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: BEJNJFOC20210739122

Write-up: VOMITING; FEELING UNWELL; COLD CHILLS; FEVER; NAUSEA; MUSCLE PAIN; FATIGUE; HEADACHE; This spontaneous report received from a consumer via a Regulatory Authority [BE-FAMHP-DHH-N2021-99490] concerned an 18 year old male. The patient''s weight was 60 kilograms, and height was 175 centimeters. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number were not reported) dose was not reported,1 total administered on 25-JUN-2021 for covid-19 immunisation. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On 25-JUN-2021, the patient experienced vomiting, feeling unwell, cold chills, fever, nausea, muscle pain, fatigue, headache. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from vomiting, feeling unwell, cold chills, fever, nausea, muscle pain, fatigue, and headache on 26-JUN-2021. This report was serious (Disability Or Permanent Damage).; Reporter''s Comments: Treatment - No Evolution of the ADR - Recovered: 24 hours. ADR description - Vomiting; Sender''s Comments: V0 20210739122- COVID-19 VACCINE AD26.COV2.S-Vomiting. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s). V0 20210739122- COVID-19 VACCINE AD26.COV2.S-Feeling unwell, cold chills, fever, nausea, muscle pain, fatigue, and headache. This event(s) is labeled and is therefore considered potentially related.


VAERS ID: 1422785 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Unevaluable event
SMQs:

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

Write-up: UNKNOWN


VAERS ID: 1422846 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 3 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Headache, Nausea, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad)

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

Write-up: 24y/o AD female w/Dizziness,nausea,HA,Vomiting,SOB, after receiving Moderna vaccine @0800 today. Denies diarrhea or any other symptoms.


VAERS ID: 1423302 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014C21A / 2 - / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Body temperature increased, Malaise, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amlodipine, Plavix, Zofran, Benazapril, Metoprolol, Famotadine, Tylenol, Acarbose, Breo Elipta, ASA, Trajenta, Atorvastatin, Incruse Ellipta, Methylprednisone, Xanax, Sertraline, Novolog, Metformin
Current Illness:
Preexisting Conditions: COPD, HTN, CAD, CKD, DM II, PVD
Allergies: NKA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Resident developed elevated temp of 101.2 with malaise, nausea and vomitting


VAERS ID: 1423374 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-01
Onset:2021-06-24
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Fatigue, Headache, Injection site pain, Lethargy
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (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: Benazepril and Androgel and Saw Palmetto
Current Illness: Hypogonadism, Hypertension
Preexisting Conditions: Hypogonadism, Hypertension
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, fatigue, pain at injection site, weakness, lethargy, tiredness


VAERS ID: 1423420 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-22
Onset:2021-06-24
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Ear 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HX of Hives
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: After the second vaccine the patient had a large swollen area starting at the level of her left ear extending down the face to about the jaw


VAERS ID: 1423465 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-06-22
Onset:2021-06-24
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041B21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Lymphadenopathy, Sluggishness
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: Patient denies
Current Illness: Patient denies
Preexisting Conditions: Patient denies
Allergies: Patient denies
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Patient called health department on 6/24/21 @ 0900 to report that she received the 2nd Moderna Covid Vaccine on 6/22/21 and "felt sluggish for a few days, but I woke up this morning and noticed a lump on my collar bone and it moved with I pressed on it". When asked patient reports not having any shortness of breath, difficulty swallowing or dizziness or change of vision. Patient encouraged to contact her PCP but patient reports "I don''t have one, do I need to go to the ER" Nurse once again verified patient was not having any difficulty breathing or any other reportable symptoms.


VAERS ID: 1423470 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-13
Onset:2021-06-24
   Days after vaccination:72
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 2 RA / IM

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

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

Write-up: TESTED COVID-19 POSITIVE ON 06/24/2021


VAERS ID: 1423472 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-05-14
Onset:2021-06-24
   Days after vaccination:41
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Dysmenorrhoea, 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: Nond
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Men?s trail period bleeding and cramping


VAERS ID: 1423485 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-11
Onset:2021-06-24
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 - / -

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

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

Write-up: Patient received second dose of Pfizer on June 11th, 2021 and a rash appeared on entire posterior side of back. Patient stated he wanted to come back to Center to get it checked out. Patient also stated that he has a past medical history of hypertension and hyperlipidemia. EMS was called and vitals were taken. EMS advised patient to go to ED and patient complied. BP: 163/108. HR: 86.


VAERS ID: 1423519 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-06-12
Onset:2021-06-24
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038121A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Axillary pain, Nausea, Rash
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: severe rash, pain under armpit, rash is painful and spreading , nausea


VAERS ID: 1423531 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-07
Onset:2021-06-24
   Days after vaccination:48
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B21A / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Arrhythmia, Chest discomfort
SMQs:, Anaphylactic reaction (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (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:
Preexisting Conditions:
Allergies: Dust
Diagnostic Lab Data: None I don?t have medical
CDC Split Type:

Write-up: I have been having heaviness of the chest when leaning forward. And concerning amounts of heart rhythm issues during my normal exercises that I have been doing for years. I thought my heart was going to stop I had my finger over 911 ready to call if it did.


VAERS ID: 1423634 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 2 LA / IM

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

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

Write-up: Patient received first dose of Moderna COVID 19 vaccine on 6/5/21 and second dose on 6/24/21. Second dose was given too soon; prior to 28 days and prior to the 4 day grace period.


VAERS ID: 1423638 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-06-12
Onset:2021-06-24
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Menstruation delayed, Menstruation irregular
SMQs:, Fertility disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: Sulfa
Diagnostic Lab Data: Non existent period
CDC Split Type:

Write-up: Period is a week late. It?s never irregular. I was perfectly healthy before this. There is no reason for my period to be late.


VAERS ID: 1423639 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Chest pain, Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Patient described increased heart rate and eventually chest pain after 20 minutes of receiving vaccine. Ambulance was called to assist - relayed heart rate and blood pressure was normal and deemed it "situational anxiety". Mom decided to have patient transported to ER.


VAERS ID: 1423704 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 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: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: AFTER GETTING VACCINE THE PATIENT STARTED FEELING DIZZY , HE GOT VERY SWEATY , FELT LIKE FAINTING


VAERS ID: 1423713 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 LA / IM

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

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

Write-up: Patient fainted while waiting in the seating area after the vaccine was administered. Paramedics were called and took patient to hospital for further testing and evaluation


VAERS ID: 1423718 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose normal, Dizziness, Fall, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), 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? 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: b/p normal blood sugar normal lungs and pulse normal
CDC Split Type:

Write-up: pt got vaccine at 11:30, went to the waiting area to wait out 15 mins. got light headed, slid out of chair into floor. pharmacist seen her draw up like she was about to seize. pt straightened out and came to. when pt woke up she did not know how she got into the floor. 911 was called. pt was stabilized before 911 arrived. Pt states she had not ate before vaccine was given. Pt was gave a bottle of water and crackers. ems checked B/P, blood sugar, pulse, listened to lungs. all was normal. Pt was slightly light headed but remained instore for monitoring and until resolved. family was called to pick pt up.


VAERS ID: 1423729 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injury associated with device
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data: patient was sent to the ER. Was not able to extract the needle with sterile tweezer
CDC Split Type:

Write-up: The needle went into the arm after the vaccine. The syringe 1ml (25Gx1") was used. The needle could not be extracted from the left deltoid.


VAERS ID: 1423750 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-06-22
Onset:2021-06-24
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW00181 / 1 LA / SYR

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

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

Write-up: Mild/Moderate Dizziness/Vertigo


VAERS ID: 1423756 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-06-18
Onset:2021-06-24
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Headache, Pain in extremity, 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), Tendinopathies and ligament 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: yaz birth control, spironolactone 50nonmg qd
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient parents reported their daughter "froze 2 times like a seizure happened" a few days after the second Pfizer dose had been given. Patient also reported dizziness, arm soreness, and many severe headaches. patient mom said her daughter has recovered, however she continues to have some headaches.


VAERS ID: 1423764 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Nothing recorded in our chart, unsure if patient is taking anything.
Current Illness: None reported.
Preexisting Conditions: None reported, per patient she does not see any primary care doctor.
Allergies: None on file.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine that was given was expired. Vaccine was diluted and drawn up at 2pm on 6/23/21 and expired on 6/23/21 at 8pm. Dose was given at 9:20am on 6/24/21.


VAERS ID: 1423770 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Face injury, Fall, Haemorrhage, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none reported
Preexisting Conditions: none reported
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: After Moderna vaccine was given patient fainted from a standing position in our waiting area. A one inch cut was sustained to her left forehead in the fall. Patients pulse and breathing were checked while compression to forehead with gauze was used to stop bleeding. EMS responded and took over her care. Patient was transported to medical center.


VAERS ID: 1423792 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Eye pruritus, Rash, Rash pruritic
SMQs:, Anaphylactic reaction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Increased SOB." feels like I am breathing through a straw". Itchy rash chest, neck and eyes. " feels like I got hit by a truck".


VAERS ID: 1423802 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

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

Write-up: patient indicated via translator pain in the middle of the chest. I requested that he remain in the area of the pharmacy longer time--he refused. I advised him to go to an emergency department if the pain returned or got worse ASAP


VAERS ID: 1423806 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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: tylenol
Current Illness:
Preexisting Conditions:
Allergies: penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was hospitalized for 7 hours for difficulty breathing , facial numbness and pain


VAERS ID: 1423823 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Disorientation, Pallor, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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 was nervous and teary eyed in the vaccination booth, prior to administrating. She is a minor so her Father accompanied her. We were in the booth for a few minutes where I was trying to get her to relax and breathe. Her father was there the entire time. I gave the Pfizer vaccine and she stated "that was it?" She seemed ok upon leaving the booth. Her and her Father sat in the observation area directly in front of the pharmacy. About 5 minutes passed when her Father tapped on the window. Went out to check on the patient and she was pale and little disoriented. She ended up throwing up as well. We gave her a bag so she wouldn''t have to stand up and could stay near her father, to prevent a fall. ?We gave her a cold compress and a water and had her stay for 30 minutes. By the time she left, she had her color back and was able to say that she was feeling much better. Her father was not surprised that she had a reaction like this and stated that she usually has form of reaction like to vaccines. She was ok by the time she left and they both stated they''d be back for the second vaccine.


VAERS ID: 1423843 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-03
Onset:2021-06-24
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

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

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

Write-up: HE HAD CHEST PAIN AT THE NIGHT OF VACCINATION AND IT WENT THROUGH FOR 6 HOURS. FELT BAD FOR 2 DAYS, AND STILL FEEL BAD


VAERS ID: 1424015 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Headache, 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: IBUPROFEN
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NO KNOWN DRUG ALLERGIES
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Within minutes of receiving vaccine, pt verbalized feeling dizzy with a headache. Pt became pale and diaphoretic. Pt''s lower extremities were elevated, ice pack applied to back of the neck and vital signs obtained. Juice and crackers were given. Within several minutes, Pt verbalized symptoms resolved and was ready to go home. Pt will lie down to receive second dose of Pfizer vaccine.


VAERS ID: 1424038 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dyspnoea, Feeling abnormal, Headache, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (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: heart , lung disease, COPD, asthma, CAD 7 stents placed
Allergies: morphine and statins cause anaphylaxis
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt felt strange followed 5 min later by feeling short of breath and severe pain in head, mild wheezing auscultated


VAERS ID: 1424063 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure decreased, Loss of consciousness, Nausea, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: pt had nausea vomiting and passed out BP dropped


VAERS ID: 1424071 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-06-03
Onset:2021-06-24
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 2 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 - / IM

Administered by: Senior Living       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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Famotidine 20 mg QD, Albuterol nebs tx QID, Fursomide 20 mg QOD, Atorvastatin QD, Miralax QD, Mucinex QD
Current Illness: Diagnosis are: Acute kidney failure, personal history of covid, dementia, g-tube, heart failure, frequent pneumonia
Preexisting Conditions: as above
Allergies: Sulfa antibotics
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: No adverse effects per Assist, at Healthcare Facility.


VAERS ID: 1424099 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / IM

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

Write-up: chest pain starting 2am on day following second Pfizer COVID dose, advised pt''s mother to contact physician for guidance. pt''s mother states severity has decreased since that time. Mother reported it to pharmacy at 11:30am.


VAERS ID: 1424158 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Unevaluable event
SMQs:

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

Write-up: No adverse effects occurred. Janssen was given as pt denied multiple times that he received any COVID-19 vaccines. Pt did wait 15 minutes after administration and no adverse effects.


VAERS ID: 1424163 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-20
Onset:2021-06-24
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Face oedema, Periorbital oedema, Rash
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Yaz, clonazepam, Prozac
Current Illness: allergic rhinitis
Preexisting Conditions: Anxiety, depression, seasonal allergies
Allergies: Codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt was seen on 6/8 for same issue, but it was 10 days post covid 19 pfizer vaccine #1. Today, pt is here with similar symptoms but worse; rash covering face, neck, spreading over body; bil periorbital edema, facial edema. Pt''s second covid vaccine was 4 days ago. Today she was prescribed prednisone oral for 9 days and triamcinolone ointment.


VAERS ID: 1424169 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Pain, 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: Rash on left leg like dozens of bug bites, slight rash on right leg, fatigue, headache, body aches.


VAERS ID: 1424184 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 1 LA / IM

Administered by: Pharmacy       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: None
Current Illness: Not aware of any
Preexisting Conditions: Nothing documented
Allergies: Xanax
Diagnostic Lab Data: Unknown at this time.
CDC Split Type:

Write-up: Patient was stating that he was experiencing chest pain today after his immunization. He was advised to contact his doctor office for further evaluation.


VAERS ID: 1424189 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: Syncope, vomiting. Resolved after PO hydration and trendelenberg


VAERS ID: 1424196 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 3 LA / IM

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

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

Write-up: patient had a third dose of the Moderna vaccine by mistake. he received his first dose at another clinic - unknown to us - in January of 2021. Pt then received a 2nd dose at our clinic on 5/27/2021 and then another dose today 6/24/2021 - we thought this was his 2nd dose but when we went to enter his vaccine in the state vaccine registry saw that he had already had two doses.


VAERS ID: 1424200 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 2 LA / IM

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

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

Write-up: Second shot was given 61 days after first shot


VAERS ID: 1424212 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blood glucose, Electrocardiogram, 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), 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? 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: After receiving his second dose of the Pfizer vaccine, this patient lost consciousness while sitting in the chair. The staff slowly assisted patient into a lying position onto the ground. Patient visibly pale. Oxygen then applied at 2L via NP and vital signs were taken and stable. Approximately 30 seconds later, patient regained consciousness. Patient was able to identify name and date of birth. Patient verbalized no pain, nausea nor dizziness at this time. Water and ice pack provided for patient. Patient then slowly transferred into sitting position and was placed in observation area. Patients mother declining further transfer to urgent care. Staff encouraged further evaluation. 911 called around 12:15. Paramedics arrived shortly after and performed an EKG and blood sugar check. Patient verbalizing feeling better at this time. Patient then left clinic walking independently accompanied by his mother and siblings.


VAERS ID: 1424224 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 1 - / -

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

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

Write-up: Patient arrived at our vaccine event. Filled out the Moderna Screening form and answered NO to having received a covid-19 vaccine previously. Staff did a 2 person verification on her screening and felt it was safe to proceed and she met all of the guidelines. Once the patient left the facility and when we were placing the vaccine into our state Alert system is when it was made clear she had already received a Pfizer vaccine on 5/24/21. She was within the except able window to receive her 2nd dose but she got it with another vaccine.


VAERS ID: 1424226 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Autoscopy, Dizziness, Erythema, Pruritus
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular disorders (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: Mumps Vaccine---She was a child. Did not know how old she was.
Other Medications: Levothyroxine 125mcg, Fluticasone 50mcg nasal spray, lisinopril 30mg, vitamin d3 400IU, cetirizine 10mg, Atenolol 50mg, Clonazepam 0.5mg is what is listed in her patient profile at the pharmacy.
Current Illness: None reported
Preexisting Conditions: Hypothyroidism, Hypertension , Generalized Anxiety disorder, low vitamin D, seasonal allergies, Fibromyalgia, Irritable bowel syndrome, Diverticulitis, and spastic colon.
Allergies: When tested for environmental allergens (trees, pollen, grass, etc) at the allergist had a severe reaction that required epinephrine. She had mumps and then received a vaccine for it and had an anaphylactic reaction. Patient reported allergy to codeine and Percocet and her reaction was euphoria ( which is a side effect).
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient and I went over her past medical history in detail and her reactions to allergy testing and previous vaccines. She wanted to proceed with vaccination. I agreed and recommended a 30 minute minimum wait for observation. I administered the vaccine and within five to ten minute she began to feel like she was having an out of body experience, her face became red and itchy, and she was dizzy. She sat in the lobby for close to 15 minutes. I checked in with her and she was not feeling any better so I administered 50mg of liquid diphenhydramine to the patient and gave her a bottle of water. She stayed in the lobby for a total of an hour and a half from start of vaccination to finish. I called her primary care provider after I had administered the diphenhydramine and related all the details of what happened to her. She agreed that the course of action taken was appropriate and to tell the patient to rest and if she was no better to come in and be seen the following day. The patient had an epipen at home and she was instructed to use it if her lips or throat began to swell and call 911. The patient and her primary care provider are going to assess if a second dose is safe following this occurrence. While she was in our care she did not have and issues with her breathing or swelling of the lips or throat.


VAERS ID: 1424228 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Pallor
SMQs:, 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: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type: CA134B1001

Write-up: Pt stated that he was feeling lightheaded and dizzy while sitting in post-vac after receiving Pfizer (EW0196) vaccine. Pt became pale and clammy to touch and sat down on floor. Pt''s mother stated "he gets like this when he gets shots." Pt denies any SOB, itching, pain, or other discomfort. Pt has no orofacial swelling or visible hives/rash. Pt was given juice to drink and stated that he felt better afterward. Pt''s skin returned to normal and he sat up in a chair. Pt was released at 12:40 into care of mother. Pt stated he was no long symptomatic and felt "back to normal." Pt left clinic with mother, walking with steady gait, and in no apparent distress.


VAERS ID: 1424230 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Asthenia, Headache, Malaise, Muscle spasms, Nausea
SMQs:, Acute pancreatitis (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Severe stomach pain/cramps 7/10, Nausea, general malaise, headache, weakness


VAERS ID: 1424240 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose normal, Dizziness, Vaccine positive rechallenge
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: dizziness for 1 hour after the first dose of Covid 19 pfizer
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt stated that she felt dizzy shortly after covid 19 Pfizer vaccine. Patient has been drinking Gatorade and symptoms did not resolve after about 30 minutes. Asked mother to see if she wanted us to call 911. Mother requested us to call then paramedics came. Paramedics checked blood pressure, oxygen and glucose levels and everything came back within normal limits. Paramedics advised mom to either keep an eye on her at home or take her to emergency room. Mom said she will take the patient to ER. Paramedics helped the patient leave the store.


VAERS ID: 1424242 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / IM

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

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

Write-up: Fainted with vaccine. lasted about 30seconds to minute. was fine after that


VAERS ID: 1424245 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

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

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

Write-up: Patient walked from pharmacy to front of store and promptly collapsed at the front registers. He was given slight fluids by bystanders before the ambulance was called, after ambulance was called the responder on the phone informed us to stop the patients intake of fluids.


VAERS ID: 1424246 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Pallor, Seizure, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluoxetine
Current Illness: Confirmed no other illnesses at time of vaccination and up to one month prior.
Preexisting Conditions: Depression
Allergies: Confirmed no allergies to medications, food, or other products.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient began to slouch upon sitting in the waiting seat approximately 1-2 minutes after receiving their second dose of the COVID19 (Pfizer/BioNTech) vaccination. Pharmacist immediately assisted patient and instructed for technician to call 9-1-1 immediately. We were able to catch the patient as they were falling out of the seat. Patient then began to seize for 5 seconds. Post seizure the patient was pale but cognizant and able to answer questions correctly (i.e. Name, DOB). Patient then began vomiting profusely. Patient reported no history of seizures, however reported previous an episode of fainting 3 years ago due to heat. Patient was monitored, given bag for emesis, water for rehydration, and ice pack until EMS came.


VAERS ID: 1424270 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Rash, Stress
SMQs:, Anaphylactic reaction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Approx. 15 minutes after vaccination to rt deltoid muscle, pt began breaking out on both arms with small, raised bumps. Gave 10ml Benadryl 12,5/5 solution. Approx. 10 minutes later pt indicated he was having "a little" difficulty breathing. Dad said he has Ehlers Danlos Syndrome and that his breathing was likely due to stress reaction. pt was ok a short time later and dad said if reaction continued, or his breathing worsened that he would take him to the ER. I followed up with dad an hour later and dad said the bumps were still there, but son''s breathing was fine.


VAERS ID: 1424275 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C1A / 2 RA / IM

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

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

Write-up: Given Moderna vaccine off label. Patient was 16 years old.


VAERS ID: 1424278 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Diabetes mellitus, Dyspnoea, Hyperhidrosis, Skin warm, Tongue pruritus, Tremor
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: the patient came back med opts 1 shaky, warm, and slightly sweaty. she said her tongue was itchy and had slightly labored breathing. Patient also said she was diabetic and was given apple juice. Vitals- TIME: 4:37 HR: 116 RESP: 14 BP:168/100 SP02: 94%


VAERS ID: 1424296 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 1 LA / IM

Administered by: School       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? 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 was given first dose of Moderna vaccine intramuscularly in left deltoid on June 24, 2021. Patient had already received first dose of Janssen COVID-19 vaccine on April 7, 2021. Patient exhibited no symptoms or side effects and was monitored for 30 minutes post-vaccination.


VAERS ID: 1424335 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Haemorrhage, Immediate post-injection reaction, Induration, Lip discolouration, Malaise, Peripheral swelling, Skin discolouration
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Right after administration, patients arm started bleeding a lot so we cleaned up the blood and were going to switch out the bandaid and noticed her arm was already really swollen and hard (like a big marble under the skin). She then said that she was feeling really dizzy and thought she was going to pass out. She turned white and said she felt very sick. She leaned back in her chair and a cold ice pack was applied to her forehead and the injection site. This continued for about 30 minutes and then colored returned to her face and lips and she said she was feeling much better.


VAERS ID: 1424344 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Dyspnoea, Flushing, Pharyngeal swelling, Swollen tongue, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: D-mannose, melatonin, prenatal vit, vit D3, vit b6, melatonin, cal-mag-zinc
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa, penicillins
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swelling of tongue and throat, flushing, hives, shortness of breath, cough within 45 min of injection


VAERS ID: 1424363 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fall, Hyperhidrosis, Loss of consciousness, Seizure like phenomena
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), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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 SEIZURE A LONG TIME AGO. RECENTLY JUST RESTART ON SEIZURE MEDICATION.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: AFTER GETTING HIS 1ST DOSE OF MODERNA VACCINE, PATIENT SAT IN THE OBSERVING AREA. AND WITHIN 2 MINUTES OF RECEIVING THE VACCINE, PATIENT HAD A SEIZURE LIKE SYMPTOMS FOR 1-2 SECONDS AND HE FELL OFF THE CHAIR. HIS MOTHER WAS THERE TO CATCH HIM. I CAME RUNNING OUT TO ASSIST. HE REGAINED CONSCIOUSNESS ALMOST IMMEDIATELY AND REMEMBERED EVERYTHING THAT HAPPENED. BUT HE TOLD ME THAT HE FELT VERY DIZZY. I HAD HIM LAY DOWN ON HIS SIDE. HE WAS ALSO SWEATY. HE LAY ON THE FLOOR FOR THE NEXT 10 MINUTES, DURING THAT WHOLE TIME HE WAS ALERT AND AWAKE. ONCE HE FELT BETTER AFTER 10 MINUTES LATER, HIS MOTHER TOOK HIM HOME. WE DIDNOT HAVE TO CALL AN AMBULANCE FOR HIM.


VAERS ID: 1424370 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Limb discomfort, Palmar erythema, Palpitations, Pruritus
SMQs:, Anaphylactic reaction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Left arm heaviness, palmar erythema and itching, shortness of breath, palpitations, lightheadedness


VAERS ID: 1424378 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-06-19
Onset:2021-06-24
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cellulitis, Injection site swelling, Injection site warmth, Physical examination
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: PHYSICAL EXAM ONLY
CDC Split Type:

Write-up: ON 6-24-2021 PATIENT NOTICED SWELLING AND WARMTH AT INJECTION SITE ON ARM. CALLED PHARMACY. SINCE IT WAS 5 DAYS POST INJECTION SHE WAS ADVISED TO CONTACT MD . MD WAS CONTACTED AND PATIENT ADVISED TO CONME IN FOR OFFICE VISIT. AFTER EXAM IT WAS DETERMINED TO BE CELLULITIS. AN ANTIBIOTIC WAS PRESCRIBED.


VAERS ID: 1424379 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

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

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

Write-up: after 15 minutes patient fainted and collapsed in store then pharmacist came and patient was awake and breathing and very pale pharmacist was assisting him then 911 was called and came and took patient to hospital


VAERS ID: 1424382 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Haematemesis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal haemorrhage (narrow)

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

Write-up: vomiting blood


VAERS ID: 1424389 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 - / -

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

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

Write-up: Patient stated he felt as if he was going to faint and that this feeling happens often when he receives shots or sees needles. EMS was called and EMS took vitals. BP: 113/62. HR: 60. Patient stated he felt better after several minutes and EMS sent patient home.


VAERS ID: 1424393 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immediate post-injection reaction, Injection site pruritus
SMQs:, 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: HAD ITCHING AT INJECTION SITE FOLLOWING FIRST DOSE OF MODERNA
Other Medications: UNKNOWN
Current Illness: COUGH FROM SEASONAL ALLERGIES
Preexisting Conditions: PT WAS RECENTLY DISCHARGED FROM REHAB, DID NOT OFFER WHAT TYPE OF REHAB
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: PATIENT HAD ITCHING AT THE INJECTION SITE FOLLOWING THE FIRST DOSE AND WAS STARTING TO ITCH IMMEDIATELY AFTER ADMINISTRATION OF THE SECOND DOSE (TODAY). NO RASH OBSERVED. OFFERED PATIENT LIQUID BENADRYL AND SHE ACCEPTED. GAVE PATIENT 10ML OF BENADRYL 12.5MG/5ML WHILE SEATED IN THE OBSERVATION CHAIR. PATIENT DRANK WITH NO ISSUES AND DID NOT COMPLAIN OF ITCHING AFTER ADMINISTRATION.


VAERS ID: 1424405 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Ear pain, Hyperhidrosis, Hypoaesthesia, Oropharyngeal pain
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre 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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt described feeling clammy, sweaty, having a sore throat, ear pain, and numbness in arm


VAERS ID: 1424410 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure increased, Muscle tightness, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: pt reported taking Vit. D and B otc
Current Illness: Elevated Blood pressure, Nausea, Vomiting, Jaw tightness
Preexisting Conditions: none reported
Allergies: NKDA reported
Diagnostic Lab Data: 2:50pm -bp 226/142 pulse 88
CDC Split Type:

Write-up: Pt presented for 1st dose Moderna Vaccine. Reviewed and completed required documentation prior to administration. Around 5 min. post immunization pt exhibited N/V, supervisor informed. pt vitals were taken, informed provider CRNP. instructed oral nausea medication. pt refused EMT at that time. Pt given Zofran 4mg PO. Pt was unable to keep down. Vitals were taken every 10 min. with elevated bp. Informed Dr. of situation and urged pt to go to ER. Pt agreed, EMT was contacted and arrived around 20 min. after. Prior to EMT arrival pt C/O left jaw tightness. EMT arrived and transported pt to Hospital


VAERS ID: 1424414 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-19
Onset:2021-06-24
   Days after vaccination:97
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 LA / IM

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

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

Write-up: Patient stated he had not received the Covid vaccine before. Patient was given first dose of Pfizer vaccine on 06/24/2021. In Right deltoid at 1:15pm. When documenting the vaccination, CAIRS information was populated that the patient had received the J&J vaccine in march.


VAERS ID: 1424417 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

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

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

Write-up: Patient was given an expired Pfizer Covid 19 dose (expired 6/23 9:30pm). Patient was informed and given another dose.


VAERS ID: 1424430 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-06-01
Onset:2021-06-24
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Loss of consciousness, 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), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (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: Patient often passes out with vaccine.
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: None ordered
CDC Split Type:

Write-up: Complaints of seeing stars and feeling faint. Wheel chair and stretcher pad with legs up. Mom states she passed out with needle sticks or the sight of blood. 94/62, pulse 92, resp 14. Passed out a for few seconds. Mom declined EM. Pretty sweaty. 97/65, 92/14 states she feels better. Given water and cool cloth. 10:45 am 91/63, 97/14. Patient states no longer feels faint. Setting up . 11:00 Patient states she feels normal. Skin warm, dry and pink. Standing vital signs 116/86, 16. Mom and patient comfortable and walks without problems. Instructed to notify staff prior to vaccine so she can lay done before administration.


VAERS ID: 1424449 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood test, Loss of consciousness, Pallor, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), 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: Antidepressant
Current Illness: none
Preexisting Conditions: Depression
Allergies: NKA
Diagnostic Lab Data: Blood work
CDC Split Type:

Write-up: 13 year old female received#2 Pfizer vaccine and within 5-10 minutes after her vaccine she was sitting in post observation with her father when one of our employees called over to me that she was fainting. I ran over to the girl and she had passed out-she was sitting in the chair and did not fall. She was breathing with a pulse of 77- her color was pasty and she was not responding verbally. She was very limp and did not awake after multiple attempts with ammonia inhalant, calling her name and rubbing her chest. 911 was called immediately and female was transported to Hospital within in 20 minutes of incident. I spoke with her stepmom and she informed me that she was sleeping now and is doing ok. They did blood work at the hospital and did not find any issues. Step mom states it took 1 1/2 hours for her color to return. She did tell me that stepdaughter has had syncope issues before and is on antidepressant med that may have caused this. We were not aware of this during time of vaccination.


VAERS ID: 1424453 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Gait disturbance, Hyperhidrosis, Lacrimation increased, Nasal congestion, Tunnel vision
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Optic nerve disorders (broad), Retinal disorders (narrow), Vestibular disorders (broad), Lacrimal disorders (narrow), Hypoglycaemia (broad)

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

Write-up: Pt received JJ vaccination, sat in the observation area for 15 minutes, when his 15 minute observation time lapsed the patient got up to leave and I noted pt walking towards the exit with a staggered gait. I immediately asked the patient if he was ok and got him seated. Pt noted to be diaphoretic with no signs of distress. Pt was breathing and speaking in clear complete sentences and denied chest pain, shortness of breath and swelling to the mouth/ throat. Pt stated he started to experience tunnel vision when he got up and felt dizzy. Its vitals were taken and noted to be stable. I offered to call EMS which patient declined. Pt drank water and ate chips while being observed and vitals were repeated approximately 10 mins later at which time patients vitals were stable and diaphoresis resolved. While patient was being monitored I noted he seemed to be experiencing nasal congestion and left eye watering. Pts lungs remained clear to auscultation bilaterally. I offered to call EMS again and pt agreed. I called EMS who arrived approximately 4 mins later. Pt was evaluated by EMS and taken to local hospital with a stable disposition.


VAERS ID: 1424458 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

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

Write-up: Hives


VAERS ID: 1424461 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 RA / IM

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

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

Write-up: Post vaccination syncope probable due to vasovagal reaction


VAERS ID: 1424581 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 RA / 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: N/a
Current Illness: n/a
Preexisting Conditions: diabetes
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient got dizzy immediately after getting vaccine at the pharmacy. After sitting down for few minutes and drinking water , patient was perfectly fine and went home with parent.


VAERS ID: 1424595 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: not applicable
Current Illness: not applicable
Preexisting Conditions: not applicable
Allergies: not applicable
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was scheduled to receive vaccine only 2 weeks after the first dose. No obvious problems here in the clinic. Error was not uncovered until after patient left office.


VAERS ID: 1424599 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 2 LA / IM

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

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

Write-up: The patient had the first dose 5/27/21 which was reported earlier and this was the second dose.


VAERS ID: 1424601 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Oropharyngeal pain, Pain
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: Patient complains of shooting pain at the throat on one side, and pressure/pain in the chest one day after receiving second dose of Pfizer covid-19 vaccine.


VAERS ID: 1424603 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-06-21
Onset:2021-06-24
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027B21A / 2 LA / IM

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

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

Write-up: Redness and swelling at injection site


VAERS ID: 1424604 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Dizziness, Feeling abnormal, Skin discolouration
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: COPD and Previous Cardiac event (heart attack) more than 1 year ago.
Allergies: Penicillins
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient began to get sick at stomach post imz and stood up to try and feel better. Patient then became lightheaded and informed us that something was wrong. she then sat down and I went to help her. I stayed with her and talked to her the whole time while she sat there. She never became unconscious to my knowledge and I kept her pulse the whole time. After a minute she started to regain her color and she received some water to help her cool off. After about 10 minutes she left the store and I escorted her to her vehicle and she stated she was doing good.


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