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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 97 out of 5,069

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VAERS ID: 1424608 (history)  
Form: Version 2.0  
Age: 71.0  
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 EW0198 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Dyspnoea, Electrocardiogram, Nasal pruritus
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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: pt took one 25mg benedryl after dose. had forgot really allergy med the day before
Current Illness: unknown
Preexisting Conditions: allergies kidney problems
Allergies: general allergies
Diagnostic Lab Data: BP, HR, EKG all with in range
CDC Split Type:

Write-up: Pt. received vaccine from intern pharmacist, as she proceeded to waiting area, she began to feel itchy nose, shortness of breath, and mild cough. 911 was called. as she waited her son in law bought her Benedryl 25mg and she took it. when 911 arrived all vitals well within range and she was stable. 911 left and pt did not go with them, she went home. pt stated that she usually takes allergy medications and had forgotten yesterday.


VAERS ID: 1424609 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-04-22
Onset:2021-06-24
   Days after vaccination:63
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Oligomenorrhoea
SMQs:, Fertility disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: After first Covid vaccine I had head splitting headaches, everyday after day three and then for 2 weeks.
Other Medications: Ibuprophen, melatonin,
Current Illness: none
Preexisting Conditions: sinusitis, low back pain due to arthritis.
Allergies: sulfa drugs, YAZ birth control
Diagnostic Lab Data: none, will go to Dr. for evaluation if I miss a third cycle.
CDC Split Type:

Write-up: I have not had a monthly mensural period since my last Covid Shot. As of todays date, I have missed two period cycles, remarkable because I was very regular. I am not menopausal. I have had tubal ligation, I am not pregnant.


VAERS ID: 1424611 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
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 FA6780 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Product preparation issue
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ambien 5 mg once daily at bedtime, Flomax 0.4 mg once daily, HCTZ 25 mg once daily, Lipitor 20 mg once daily and Metformin 500 mg two tablets twice daily.
Current Illness:
Preexisting Conditions: Diabetes, Hypertension
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented to clinic for second Pfizer vaccination. The Pfizer vaccination was administered by an MA undiluted.


VAERS ID: 1424616 (history)  
Form: Version 2.0  
Age: 60.0  
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 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Nuts-peanuts, Pistachios
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patients started complaining about feeling itchy on abdomen and legs. upon assessment of patient no visible redness, irritation, or bumps present on patient''s skin. Vitals were taken at 0955 BP: 118/70, HR: 76, RR: 20, O2 Sat:96%. Offered patient water and called provider to request if Benadryl could be given to patient who stated itching was getting worse. Provider stated was ok to administer 10mL of Benadryl HCl 12.5mg/5mL PO at 1002. Patient was monitored for 15 mins after, vitals were rechecked at 1015 they read BP: 122/76, HR: 76, RR:20, O2 sat: 98%. Patient stated she felt better after given the medicine, the itch was going down.


VAERS ID: 1424618 (history)  
Form: Version 2.0  
Age: 60.0  
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 EW0186 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Anxiety, Dysphagia, Tearfulness
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Depression (excl suicide and self injury) (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: about 15 min. after injection pt. began feeling anxious, tearful, difficulty swallowing, pt. able to drink water, speaking in full sent., no rash, no hives, no itching, voice normal, no audible wheezes noted. Team alert called and pt. taken to ED for evaluation


VAERS ID: 1424626 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
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 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Hypoaesthesia, Hypoaesthesia oral
SMQs:, Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)

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

Write-up: Vaccine @ 12:10p Left site and came back- feeling numbness in the mouth and fingers- Seen by EMT


VAERS ID: 1424629 (history)  
Form: Version 2.0  
Age: 41.0  
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 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Nervousness
SMQs:, Hypoglycaemia (broad)

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

Write-up: Patient felt nervous/afraid Denied SOB, pain, dizziness patient had anxiety attack after vaccination since childhood offered cold water and large breathing slowly


VAERS ID: 1424632 (history)  
Form: Version 2.0  
Age: 90.0  
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 EW0127 / 2 LA / IM

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

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

Write-up: patient received different vaccine on first dose and 2nd dose. first dose was moderna, second dose is Pfizer


VAERS ID: 1424634 (history)  
Form: Version 2.0  
Age: 61.0  
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 024C21A / 2 LA / IM

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

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

Write-up: Incorrect covid-19 vaccine manufacturer administered for 2nd dose


VAERS ID: 1424636 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperhidrosis, Immediate post-injection reaction, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: Immediately after receiving the vaccine, the patient became sweaty and extremely nauseous.


VAERS ID: 1424824 (history)  
Form: Version 2.0  
Age: 38.0  
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 EW0179 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 CAME TO PHARMACY TO SHOW SIGNICANT SWELLING UNDER HER LEFT ARMPIT THAT SHE WOKE UP WITH 2 DAYS AFTER SHOT WAS ADMINISTERED.


VAERS ID: 1424829 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Colorado  
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 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Oropharyngeal discomfort, Vital signs measurement
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: None
Preexisting Conditions: none
Allergies: NKDA
Diagnostic Lab Data: Lungs sounds were clear and equal bilaterally. BP 140/90 HR 118 O2 SAT 99% RA RR14
CDC Split Type:

Write-up: Patient had throat discomfort


VAERS ID: 1424833 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Colorado  
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: Other       Purchased by: ?
Symptoms: Oropharyngeal discomfort
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NKDA
Diagnostic Lab Data: Lungs clear and equal bilaterally, BP 120/80 02 Sat 95% RA HR 96 RR 14
CDC Split Type:

Write-up: Throat Discomfort


VAERS ID: 1424834 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: California  
Vaccinated:1991-02-13
Onset:2021-06-24
   Days after vaccination:11089
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / UNK LA / IM

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

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

Write-up: PT RECIEVED MODERNA VACCCINE FOR THE FIST SHOT


VAERS ID: 1424836 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Oklahoma  
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: Asthenia, Malaise, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Patient was given her first dose of the moderna covid vaccine. She briefly waited around the pharmacy afterwards then began wandering to the back of the store. Roughly 30 minutes after administering the vaccine, she came back to the pharmacy and vomited. Pharmacy staff checked on her and she stated she felt weak, nauseaus, and sick. She stated she just needed a moment to recover and did not need EMS, but the feeling did not pass, so a code white was called and EMS were called to check out the patient. They checked vitals and spoke with the patient, but she did not want to go to the hospital at that time, so she was allowed to rest in the immunization booth until she felt comfortable driving herself home. However, the feeling still did not pass, so roughly 45 minutes later she requested EMS be called again, and she was taken to the hospital.


VAERS ID: 1424853 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Massachusetts  
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 - / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Discomfort, Induration, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), 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: amlodipine, aspirin, isosorbide mononitrate, atorvastatin, Vitamin D3
Current Illness: anginal symptoms of coronary artery disease
Preexisting Conditions: coronary artery disease with history of prior myocardial infarction, hyperlipidemia
Allergies: none
Diagnostic Lab Data: Chest x-ray was ordered on 6/24/21 to image the area, results are pending
CDC Split Type:

Write-up: Patient reported he received a dose of the Pfizer COVID vaccine 1 day before onset of increasing firm nontender swelling of the left costochondral junction at the level of the 2nd rib. On exam, this area was nontender and palpated similar to a skeletal prominence but patient endorsed that this was entirely new to him. He felt discomfort deep to the swelling, but this was not worsened by touching the area.


VAERS ID: 1424858 (history)  
Form: Version 2.0  
Age: 40.0  
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 201A21A / 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: na
Current Illness: na
Preexisting Conditions: na
Allergies: na
Diagnostic Lab Data: na
CDC Split Type:

Write-up: Patient was given an expired shot. Vaccine was expired in 1 hour.


VAERS ID: 1424859 (history)  
Form: Version 2.0  
Age: 36.0  
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 EW0183 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Consciousness fluctuating, Hyperhidrosis, Hypoacusis, Vision blurred, Vital signs measurement
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Hypoglycaemia (broad)

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

Write-up: Approx. 1 min. after vaccinated pt co muffled hearing, blurred vision, swearing and in & out of conscious. Patient did not recall moving from chair to elevate feet. Vital signs at time of incident BP 98/52, Pulse 46, oxygen 97%. Patient waited for 30 minutes after episode and was evaluated by EMS.


VAERS ID: 1424870 (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 - / 1 LA / IM

Administered by: Public       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: Brief fainting episodes with prior vaccines (MMR, tetanus, and others) and with any time my blood is taken
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Brief fainting episode after the shot (I always pass out after shots)


VAERS ID: 1424872 (history)  
Form: Version 2.0  
Age: 17.0  
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 EW0183 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood glucose normal, Dizziness, Fall, Head injury, Memory impairment, Nausea, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Upon walking to recovery area patient went pale and fainted. Witnessed fall, fell and hit head on the floor. Vital signs taken: BP:110/60 HR:70 SpO2: 98% in RA. Pt initially did not recall receiving vaccine but when asked orientation questions, she answered all appropriately (A&Ox4). Within five minutes EMS on scene to assess pt. Pt could not recall last meal, BG checked and was 91. Upon sitting up pt was nauseated and dizzy. Pt transferred to ED for follow up care.


VAERS ID: 1424879 (history)  
Form: Version 2.0  
Age: 14.0  
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 EW0177 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dysarthria, Heart rate irregular, Loss of consciousness, Pallor, Skin warm, Syncope, Vital signs measurement
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), Cardiac arrhythmia terms, nonspecific (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 16:06, patient went into syncope x3. 911 was called. Blood sugar: 116, RR-14, O2SAT-98%, heart was 45 bpm. When patient awoke heart rate would stay above 80 bpm but would drop back down to mid 40''s, then she would become unconscious. Patient''s speech was sluggish. Skin was pale and warm to the touch. Constant communication was given to try to keep patient awake. Airway remained. Patient showed no signs of inflammation. 16:10, patient was awake. Alert and oriented to person, place and time. O2SAT-98%, heart rate 82, RR-20. 16:22, patient was taken by ambulance.


VAERS ID: 1425012 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: North Carolina  
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 1808986 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Fear of injection, Hyperhidrosis, Pallor, Syncope, Throat tightness
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Patient was assessed at the Pharmacy by the paramedics, his blood pressure was a little high, patient refused to go to the Hospital.
CDC Split Type:

Write-up: Patient fainted 5 minutes after the administration of the vaccine, he could still talk and told me that he was having difficulty breathing so while 911 was on the way I injected one dose of Epinephrine 0.3 mg. He was also pale and sweating. I was making sure he had a pulse, when 911 arrived they assess him and his blood pressure was a little high. After maybe 15 minutes he was feeling better and he told us that he was afraid of needles. Honestly we do not know if he was very anxious or if he had a reaction to the injection since he mentioned his throat was closing.


VAERS ID: 1425016 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
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 078C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fall, Head injury, Loss of consciousness, Nervousness, Seizure, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: All his vaccines, patient get dizzy and lightheaded
Other Medications: None
Current Illness: No illnesses or health conditions
Preexisting Conditions: No health conditions per patient
Allergies: No allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Vaccination was administered to the patient, the patient was a little nervous at time of administration. After 5 to 10 minutes of waiting in the pharmacy the patient was lightheaded and dizziness. The patient passed out and fell over, hitting his head on the wall of the pharmacy. The patient was briefly shaking/convulsing per the mother for a few seconds until the patient woke up. The pharmacy staff rushed out to the patient''s aid. The patient was confused when he woke up . We had him lay on the floor for a few minutes then helped him up to a chair to sit when he felt better. The patient explained how this has happened to him before when receiving vaccinations, he gets lightheaded and dizzy when receiving vaccinations. The patient explained how he did not take any medications or has any health conditions. The patient refused medical attention and said he felt ok as we waited with him for 5 minutes. We recommended the patient to see a doctor if he as any symptoms. The patient waited for an extra 30 minutes and said he felt fine. The patient''s mother and the patient left with the mother driving him home.


VAERS ID: 1425019 (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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Dyspnoea, Feeling hot, Headache, Hyperhidrosis, Malaise, Pallor, Vision blurred
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Client''s companion alerted EMT client was not feeling well. EMT informed PHN. Upon arrival at 1736 client sitting in chair, pale and diaphoretic. Client alert and oriented x4. EMT performed vitals at 1736: blood pressure 140/90, pulse 59, oxygen sat 100%. PHN began assessment. Client reported blurry vision, shortness of breath and feeling "very hot all over body". Client denies throat closing, no flushing noted, no swelling noted. Client diaphoretic, shirt soaked, arms and legs. Client pale and lips pale. Client reported has history of fainting with blood draws, no current medications and no known allergies. At 1740 client reports feeling "I can''t take a full breath", pulse 43. PHN calls 911 at 1740. PHN and PHN observed client using upper muscles to take breaths. PHN auscultated clear lung sounds. 1743 weak pulse, 54. Client diaphoretic, alert and oriented x4. Client reports new onset of headache at. Vitals at 1744: blood pressure 130/80, pulse 56, oxygen sat 99%. At 1747 manual pulse 58. Fire Department arrived at 1748 and assumed care. Client signed AMA and walked out of facility at 1754 immediately after Fire Dept leaves.


VAERS ID: 1425047 (history)  
Form: Version 2.0  
Age: 13.0  
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 EW0196 / 1 LA / IM

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

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

Write-up: 13 YO F, 84 lbs, presented syncope, pt fainted 2 min after COVID vaccine, pt and mom corroborated that patient had not had breakfast or lunch, this event occurred at 3:30 pm. Patient verbalized being nervous prior to vaccination. Pt could not recall last time she had water. As soon as patient complained of feeling faint, patient was handed a water bottle and blood pressure was taken, reading on left arm was 62/47 83 bpm heart rate, pt was then given a Coca-Cola and a glucose tab. Patient reported feeling better after 5 min, then began complaining that she did not feel well again. Patient then fainted again, I popped an ammonium vial, and 2 ice packs. Took BP again and was 65/50, called 911, called a code white and let store manager know and once paramedics presented to patient, patient BP was 116/75 98 bpm, pt had regained color, and stated she felt better. Mom turned down offer to take patient to hospital, as patient stated they felt better.


VAERS ID: 1425190 (history)  
Form: Version 2.0  
Age: 60.0  
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 051C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fall, Head injury, Loss of consciousness, Skin laceration
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), Hostility/aggression (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Patient experienced light-headedness minutes after receiving the vaccine during her 15 minute observation period - she briefly lost consciousness and fell out of her seat, striking her head on product shelving. She exhibited two minor lacerations approximately one inch long on her right arm and the right side of her face. She regained consciousness immediately and was fully aware of her surroundings. Patient received first aid treatment with antiseptic solution, antibiotic ointment, and bandages.


VAERS ID: 1425202 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
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 LA / IM

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

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

Write-up: Client received the COVID vaccine (Pfizer dose 1, lot # EW0187, expiration date 7/12/2021) in his left deltoid at 1835. The client reported to RN at 1705 that he was experiencing itching. RN informed EMT and RN , who responded at that time. The client stated that the itching had started "5 minutes" after he was vaccinated and he was experiencing itching on his bilateral upper and lower extremities, as well as the back of his head. The client denied any shortness of breath or chest pain. The client didn''t have any observable swelling on his head or tongue, and he had no observable rashes on his extremities or head. The client stated he had a history of hypertension but takes no medications, and he stated that he had an allergy to penicillin. The client stated that he last ate at noon. At 1710, the client''s vital signs were as follows: blood pressure 158/112, heart rate 76, respiratory rate 18, O2 97%. The client stated he did not know his usual blood pressure range. The client denied any headache and his pulses were normal. The client stated that he was feeling "heat"; the client''s skin was pink, warm, and dry. The client continued to denied any difficulty breathing. The client was alert and oriented x4. The client was offered water and oral Benadryl (50 mg) at 1710, which he accepted. At 1720, the client''s vital signs were as follows: blood pressure 152/102, heart rate 74, O2 96%. The client stated that the itching had stayed the same. Education provided to the client and his partner regarding emergency management, primary care follow up, and v-safe. At 1730, the client''s vital signs were as follows: blood pressure 150/96, heart rate 78, O2 95%. At 1735, the client stated that his symptoms of itching and heat had resolved. The client was sitting in his chair comfortably resting. At 1740, the client was able to stand without dizziness, and ambulated with a steady gait out to his car, where his partner drove him home.


VAERS ID: 1425209 (history)  
Form: Version 2.0  
Age: 37.0  
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 ER8735 / 1 - / IM

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

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

Write-up: Client received the 1st dose of Pfizer COVID vaccine (lot # ER8735 and expiration date 7/04/21) at approximately 2:48pm. PHN was doing a medical consult for a family member and noticed client touching mask and looking uncomfortable at 2:49pm. Client reports feeling nauseous and having had chest pressure for a few seconds that had already resolved. PHN request PHN to get emesis bag to provide to client. Client reports no blurred vision, no headache, no dizziness, no shortness of breath and no chest pain or pressure at this time. PHN offered client water and instructed to drink small amount, which client started to drink. PHN assist with vitals at 2:51pm: blood pressure:122/90, oxygen saturation:98%, and pulse:102. Client reports this has never happened before. PHN assess for swelling in mouth and lips-none observed. At 2:56pm RN stepped in to assist PHN, vitals are blood pressure:120/84, pulse:94, and oxygen saturation: 99%. Client reports no headache, no dizziness, no chest pain, no blurred vision, and decreased nausea. At 3:01pm, vitals are blood pressure: 122/86, pulse: 82, and oxygen saturation: 97%. Client reports no headache, no blurred vision, no chest pain, no chest pressure, no dizziness, no shortness of breath, and nausea decreasing. At 3:06pm, client reports that nausea has completely resolved. At 3:10pm, vitals are blood pressure:122/80, oxygen saturation: 100%. and pulse:72. Client reports no symptoms. At 3:20pm vitals are blood pressure:124/80, oxygen saturation:98%, and pulse:77. Client reports no symptoms. PHN ask client if she has someone to drive for her and client responds "I feel fine to drive." Provided client with ER precautions and to follow up with provider. At 3:21pm client left facility with a steady gait.


VAERS ID: 1425210 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: California  
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 050C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: heart palpitation and worsening chest pain started on 2nd day after vaccination


VAERS ID: 1425257 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A01A / 1 LA / IM

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

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

Write-up: Pt fainted in the observation area by the pharmacy. He was pale and trembling. We called 911 and the paramedics checked his BP, Blood sugar, and heart function. Everything was normal and paramedics let his wife pick him up and take him home. I spoke to pt around 8:15pm on 6/24 and he said he was feeling fine


VAERS ID: 1425259 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Hyperhidrosis, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

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

Write-up: Patient received the COVID19 Moderna vaccine dose 1. Patient began to get nauseous and vomited 7 minutes after the vaccine was administered. Additional symptoms included sweating and chill. The patient remained under observation and left with symptoms resolved after approximately 30 minutes.


VAERS ID: 1425290 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Military       Purchased by: ?
Symptoms: Arthralgia, Chest discomfort, Heart rate increased, Heart rate variability decreased, Respiratory rate increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Arthritis (broad), Dehydration (broad)

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

Write-up: Joint aches around 10 hours after vaccination. During sleep, the night after vaccination (hours 12-20 post vaccination), had increased respiratory rate, increased heart rate and decreased heart rate variability. Around 1 day after vaccine, noticed chest tightness on the right-side.


VAERS ID: 1425429 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-06-21
Onset:2021-06-24
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       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? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: none
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: Myocarditis


VAERS ID: 1425766 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Blood thyroid stimulating hormone increased, Electrocardiogram normal, Full blood count normal, Hypoaesthesia, Pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypothyroidism (broad), Hyperthyroidism (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none but completed course of amoxicillin the week prior
Current Illness: Wisdom teeth x 4 removed 9 days prior to vaccination
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: ER visit w/ normal EKG and CBC. TSH elevated
CDC Split Type:

Write-up: Lower extremity numbness/tingling and pain


VAERS ID: 1425834 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Seizure, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Systemic: Seizure-Medium, Systemic: Shakiness-Medium


VAERS ID: 1425837 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-17
Onset:2021-06-24
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Cellulitis, 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Nebilet 10mg daily.
Current Illness: None
Preexisting Conditions: HTN
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swelling to injection site, presents similar to cellulitis, pt states no significant history of adverse reactions but discloses sensitive skin and recurrent reactions with various environment exposures.


VAERS ID: 1425895 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Injection site pruritus, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)

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

Write-up: Site: Itching at Injection Site-Mild, Systemic: Numbness (specify: facial area, extremities)-Mild, Systemic: Tingling (specify: facial area, extemities)-Mild, Additional Details: feels like arm is "asleep" from injection site down


VAERS ID: 1425896 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Altered state of consciousness, Blood glucose decreased, Blood pressure decreased, Feeling cold, Hyperhidrosis, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant 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 (narrow), Dehydration (broad)

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

Write-up: During the 15-minute observation period, the patient had a fainting episode. He was briefly not aware of his surroundings and felt cool and sweaty to the touch. After a couple minutes, the patient slowly started regaining his mental status and was able to tell us his name, date, and the name of his kids. The EMTs arrived and did a thorough assessment; they determined that because the patient had not had anything to eat or drink all day up until his vaccine appointment, coupled with the fact that the patient had walked 5 minutes to the pharmacy and the weather was warm, the patient''s blood pressure and sugar likely bottomed out and caused him to faint. The patient was given an ice pack to cool down and orange juice to normalize his blood sugar. After waiting in the pharmacy for another 15 minutes, the patient was deemed fit enough to walk back home. He was advised to have something to eat and take a cool shower.


VAERS ID: 1425909 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Injection site pain
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad)

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

Write-up: Site: Pain at Injection Site-Medium, Systemic: Numbness (specify: facial area, extremities)-Medium, Additional Details: numbness in arm shot was administered in


VAERS ID: 1425912 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Seizure-Mild


VAERS ID: 1425928 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Fatigue, Headache, Muscle fatigue, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluticasone nose spray. (used once a day in morning) albuterol sulfate inhaler. (used as needed)
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: started with a headache, then the muscle fatigue set in and i was so tired i could barely get up. fever got to 101.7 fever reducer meds were taken once before trying to go to sleep. woke up in morning feeling much better, a little bit of muscle ache still but fever is down to 99.3


VAERS ID: 1426121 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / N/A LA / IM

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

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

Write-up: Inmate was a new intake into this facility. Inmate was offered the Janssen vaccine and he consented to receive. Inmate received the vaccine. Upon entering the information into the medical record, a documented history of Janssen vaccine was given on 4/27/21. Inmate did not require a second dose, but was not truthful on intake as to having previously received a vaccine. No adverse side effects reported as of the time of submitting this report.


VAERS ID: 1426135 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

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

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

Write-up: Error: Wrong Dose of Vaccine - Too Low


VAERS ID: 1426137 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Lacrimation increased, Oropharyngeal pain, Pain, Sleep disorder, Taste disorder, Vomiting
SMQs:, Acute pancreatitis (broad), Taste and smell disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Lacrimal disorders (narrow)

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

Write-up: I experienced a weird taste in my mouth shortly after the shot and the day was fine I just felt kind of drained and that night is when it started I was puking my eyes were watering my throat hurt and I couldn?t hardly sleep the next day I?ve experienced a lot of body aches


VAERS ID: 1426144 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

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

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

Write-up: Error: Wrong Dose of Vaccine - Too Low


VAERS ID: 1426148 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 LA / IM

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

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

Write-up: Vaccine injected was in syringe that had been drawn over 12 hours earlier


VAERS ID: 1426153 (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: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 LA / IM

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

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

Write-up: Vaccine injected was in syringe that had been drawn over 12 hours earlier


VAERS ID: 1426154 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 LA / IM

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

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

Write-up: Vaccine injected was in syringe that had been drawn over 12 hours earlier


VAERS ID: 1426157 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Gingival bleeding, Taste disorder, Vaccine positive rechallenge
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Taste and smell disorders (narrow), Gingival 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: Flu vaccine
Other Medications: Metropel 50 mg. Singular 10 mg, vitamin D & b12 and Biotin
Current Illness:
Preexisting Conditions: High blood pressure and asthma
Allergies: Flu shot, eggs, dairy, shell fish, penicillin, citrus fruit, trees and grass.
Diagnostic Lab Data:
CDC Split Type:

Write-up: during the first shot I experienced a bad taste in my mouth approximately 30 minutes after, upon brushing my teeth my gums bleed. Which I did not realize the connection at that time. Second shot I experienced the same bad taste and rinsing my mouth when I returned home, noticing that my gums were bleeding. They have continued to have a very slow rate of bleeding, however, it can be noticed when rinsing my mouth and taste remains.


VAERS ID: 1426454 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-22
Onset:2021-06-24
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 RA / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Clonazepam and Lisinopril
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: No information.
CDC Split Type:

Write-up: Severe chest pain went ER after 12 hours of injection.


VAERS ID: 1426475 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Dizziness, Feeling hot, Headache, Sleep disorder
SMQs:, Anticholinergic syndrome (broad), Retroperitoneal fibrosis (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: Birth control medication, containing estrogen. Acetaminophen
Current Illness: None
Preexisting Conditions: eosinophilic esophagitis
Allergies: Amoxicillin, shellfish, white fish, coconut
Diagnostic Lab Data:
CDC Split Type:

Write-up: Around 6:30pm I became very hot and dizzy, I sat down and splashed cold water on my face which seemed to help a little. I took tylenol (acetaminophen 500mg) and two glasses of water. As the night progressed, my lower back started to hurt and my headache continued to progress. I went to bed early to sleep it off but was woken up by overheating and headache. I took more tylenol around 3am and grabbed an icepack, this seemed to help alleviate the symptoms.


VAERS ID: 1426485 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Body temperature increased, Chills, Fatigue, Headache, Hyperhidrosis, Injection site pain, Myalgia, Photophobia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Noninfectious meningitis (narrow), Extravasation events (injections, infusions and implants) (broad), Glaucoma (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (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: 3000 fish oil a day, women?s multivitamin, aleve, Tylenol
Current Illness: None
Preexisting Conditions: None
Allergies: Prednisone and tramadol
Diagnostic Lab Data: None
CDC Split Type:

Write-up: On Thursday June 24th at approximately 6:00am I woke up drenched in sweat, took my temp, it was 100.7, muscle aches, severe fatigue, headache, sore arm where injection took place. I took a bath and started feeling better around 10pm Thursday evening, no fever, only a little fatigue, muscle ache, headache, chills. On Friday June 25th around 4am I started feeling feverish again, took temp, it was 100.4. I feel very fatigued again, muscle aches got better, headache got worse now sensitive to light.


VAERS ID: 1426748 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 AR / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Asthenia, Body temperature increased, Dizziness, Headache, Hyperhidrosis, Hypoglycaemia, Malaise, Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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: Known to not have any current medical history
Allergies:
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: A-Team member stated they didn''t feel good this morning and last night after taking the J&J vaccine. Around 8 am looked for the employee health nurse to get medication for nausea and headache. She was then making tea and was noted not to be feeling well and fainted. Another employee found her on the floor, and her heart rate was 115, and BP was 112/64 with a 100-degree temp Fahrenheit. A couple of hours prior, her temp was 97 degrees Fahrenheit. She looked diaphoretic, hypoglycemic, and was too weak to get off the floor, there was a maxi lift used to transfer to a wheelchair, and she was very dizzy. The only medicine taken was Pepto Bismol for nausea.


VAERS ID: 1426765 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 LA / IM

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

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

Write-up: fever$g101.2 and dry heaving (unable to vomit due to lack of eating)


VAERS ID: 1426806 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Malaise
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: Lorazepam Buspirone Duloxetine Fluvoxamine Generic ability Multivitamin
Current Illness:
Preexisting Conditions:
Allergies: Penicillin, sulfa, novacaine, kiwi
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Felt like I had a bad case of COVID-19. I was sick with COVID-19 in February, and, this was worse.


VAERS ID: 1426838 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 mother stated that patient was 12 by filling out date of birth on consent with wrong year and signed consent after reviewing information. When vaccine was processed a rejection was received "wrong date of birth". Pharmacy called insurance and confirmed year of birth. Mother then called and confirmed birth year. Patient will be 12 in 10 days, doctor told her ok to get vaccine


VAERS ID: 1426975 (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: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / IM

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

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

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


VAERS ID: 1426984 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0189 / 1 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Condition aggravated, Dizziness, Loss of consciousness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: stated he got light headed with other shots. Specific shots, unknown
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient was given injection. Aprox 2-3 minutes after, patient felt light headed. Staff placed patient in chair. Patient fainted and came back awake. Patient given crackers, water, and apple juice. He stated that he has a history of becoming light headed after shots. Patients vitals were checked, all within normal limits. Was monitored for an additional 30 minutes. Felt fine at conclusion of that time and asked to leave. Vitals were rechecked sitting and when he stood up. All were within normal limits.


VAERS ID: 1426998 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 RA / IM

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

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

Write-up: Site: Pain at Injection Site-Mild, Additional Details: Patient came in and said she had pain running up and down her arm. I looked to see if i had caused bursititis by injecting her too high, but I then realized I injected her opposite arm so bursititis was ruled out. I told her to get take 800 mg ibuprofen 3 times a day and stop if red stool appears. and asked if she had ever had any kidney trouble just encase. she said no. i said if pain is not better by tomorrow please seek additional care.


VAERS ID: 1427006 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Hyperhidrosis, Respiratory distress, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ALBUTERAL, VIT C, ATORVASTATIN, BACLOFEN, HEPARIN,
Current Illness: NONE
Preexisting Conditions: TRACHEOSTOMY, HTN, TBI, DYSPHAGIA
Allergies: NONE
Diagnostic Lab Data: NO
CDC Split Type:

Write-up: WHEEZING, DIAPHORESIS, RESPIRATORY DISTRESS


VAERS ID: 1427013 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW00177 / 2 LA / IM

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

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

Write-up: Error: Wrong Dose of Vaccine - Too Low-


VAERS ID: 1427015 (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: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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

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

Write-up: Systemic: Confusion-Mild, Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Mild, Systemic: Hypotension-Mild


VAERS ID: 1427020 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Dizziness, Fatigue
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: Unknown
Current Illness: Congestion 5/27/21
Preexisting Conditions: None reported
Allergies: None reporting
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fatigue and Dizziness 24 hours after dose. Resolving without care


VAERS ID: 1427025 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-06-22
Onset:2021-06-24
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 LA / IM

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

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

Write-up: Patient reports tender, swollen lymph nodes on same side of body as the vaccine in the armpit region beginning approximately 2-3 days post administration.


VAERS ID: 1427026 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Injection site pain, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (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: Site: Pain at Injection Site-Medium, Additional Details: whole body tremor, lower back pain. Blood O2 was 99%, HR 76bpm. Unsure of the reaction, benadryl and epipen were given. Pt went home walking after 20 mins of the event. Paramedics did not arive on time and were cancelled after pt went home. Pt was advised to see PCP


VAERS ID: 1427032 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fall, Flushing, Head injury, Hyperhidrosis, Seizure, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Seizure-Medium, Additional Details: patient fainted and hit head on chair when falling from sitting in chair to floor. bystander said that patient''s entire body was convulsing. pharmacist ran out to patient and by the time rph was by his side he was awake and coherent. EMT came and checked patient out, advised patient to go to hospital for monitoring but patient refused. patient''s mother came and picked him up.


VAERS ID: 1427037 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 2 RA / IM

Administered by: Private       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? 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: She was administered a cortisone shot as md think that the rash was probably caused by covid vaccination
CDC Split Type:

Write-up: Patient has a rash on both arms which appeared 6/24


VAERS ID: 1427038 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820096 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dermatitis allergic, 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: Systemic: Allergic: Rash (specify: facial area, extremeties)-Mild, Systemic: Rash with bumps appeared on both arms-Mild


VAERS ID: 1427051 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Decreased appetite, Dyspnoea, Fatigue, Injection site pain, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (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: Caffeine tablet
Current Illness: none
Preexisting Conditions: Trachea Installed Short term memory loss Spinal cord injury Spinal Fusion Partial undefying numbness is both legs Atrophy in top extremities Urinary issues Permanent whiplash Muscle pains Paralyzed in right arm
Allergies: doesn''t know the name but does know it''s a pain med
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Joint pains, breathing issues, loss of appetite, extreme aches in legs, pain and discomfort in injection shot, extremely tiredness


VAERS ID: 1427053 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / IM

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

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

Write-up: Fever began 12 hours after second shot, approximately 6am, and lasted throughout the day. The fever peaked around 7pm at 100.6 degrees and was responsive to tylenol. Intense body aches and chills also accompanied the fever followed by intense thirst around bedtime. All symptoms went away the following morning with lingering aches and general weakness.


VAERS ID: 1427055 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Fatigue, Headache, Injection site pain, Lethargy, Nausea
SMQs:, Acute pancreatitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: Severe headache, Nausea, fatigue , lethargic, tiredness, pain at injection site


VAERS ID: 1427092 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chills, Pain, Pain in extremity, Pyrexia, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Covid symptoms on June 1, 2021. Tested on June 2. Received positive results on June 5.
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Sore left arm around 9pm on June 24, 2021. Around 10:30pm on June 24, 2021 chills, 100 degree fever, and aches. Continued through the night and continuing as of June 25, 2021.


VAERS ID: 1427114 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immunisation, No adverse event, Syringe issue, Underdose
SMQs:, Medication errors (broad)

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

Write-up: Defective retractable syringe. Syringe retracted before dose was fully administered and over half of the dose did not make it into the patient''s arm. Administered another full dose to the patient with no issue.


VAERS ID: 1427426 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-22
Onset:2021-06-24
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Abdominal discomfort, Chest discomfort, Chest pain, Diarrhoea, Dizziness, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Noninfectious diarrhoea (narrow)

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

Write-up: Tight chest pains, extreme nausea and upset stomach, diarrhea, dizziness


VAERS ID: 1427445 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Crying, Dizziness, Immediate post-injection reaction, 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), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Not available info
Current Illness: None
Preexisting Conditions: None
Allergies: NKA/NDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Anxiety attack, 30 seconds after shot was administered Frantic crying and behavior Light headed Patient appeared to pass out, but responsive to commands and words, required assistance, was supported, no injuries. Heart rate and pulse was present The following was an experience of 30 minutes


VAERS ID: 1427452 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053C21A / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Decreased appetite, Diarrhoea, Fatigue, Haematochezia, Hot flush, Hyperhidrosis, Hypoaesthesia, Peripheral swelling, Tenderness
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal haemorrhage (narrow), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Anastiovole 1mg, Calcium +D, Vitamin D, Codeine
Current Illness: Common Cold
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt states day of 06/24/2021 after vaccination about 8:30 experiencing hot flashes, sweating, fatigued, loose stool, numbness in the leg, swollen feet tenderness. 06/25/2021 morning bloody stool, low appetite, very fatigued. States Monday 06/28/2021 plans to make an appt. with Primary.


VAERS ID: 1427457 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053C21A / 1 LA / IM

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

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

Write-up: Client was given a Moderna instead of Pzifer Covid Vaccine and the client was 16 years which is too ypung.Pfizer can be given at 16 years and Moderna is 18 years old .


VAERS ID: 1427463 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dyspnoea, Headache, Injection site reaction, Lymphadenopathy
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 2nd Dose: Experienced first symptoms around 6:00pm on June 24, including severe headache and moderate general weakness. Around 9:00pm experienced mild shortness of breath and moderate lymph node swelling under injection arm armpit which carried into June 25. This report is being submitted on June 25 and the mild shortness of breath and armpit lymph node swelling is still present. 1st Dose: Mild to moderate weakness and fatigue day after the first shot (June 3, 2021) with no additional symptoms. Symptoms completely resolved by June 4.


VAERS ID: 1427466 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dizziness, Flushing, Hyperhidrosis, Hypotension, Injection site pain, Syncope, Unresponsive to stimuli, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Site: Pain at Injection Site-Mild, Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Hypotension-Medium, Systemic: Vomiting-Severe, Systemic: Weakness-Severe


VAERS ID: 1427471 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 1 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Additional Details: Patient fainted 8 minutes after administration, came to after a few seconds. Patient was laid supine with legs elevated and EMS was called. Patient stated that he was fine, but was taken by EMS for further evaluation.


VAERS ID: 1427473 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Blood urine present, Gynaecological examination, Laboratory test, Menstrual disorder, Urine analysis abnormal, Vaginal haemorrhage, White blood cells urine positive
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Chronic kidney disease (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: Tamoxifeno 20 MG
Current Illness: No
Preexisting Conditions: Diagnosed with breast cancer in 2013 , hysterectomy done to left breast. In 2015 uterus , ovaries and reproductive system were all surgically removed as a result of the cancer causing patient early menopause.
Allergies: No
Diagnostic Lab Data: Patient was taken to hospital where blood test was performed on her which indicated no problems of blood clots. Urine test was performed on patient which as per medical providers showed slight traces of blood and small percentage of white blood cells. UTI diagnosis was cancelled out since patient was not experiencing symptoms of UTI and the reason why there was presence of blood in the urine was due to the vaginal bleeding, pelvic exam was performed On patient and there were indications of blood spots in the vaginal walls. As per physician the cervix is surgically stitched shut and there was no explanation as to where the blood could be coming from. Patient has never experienced vaginal bleeding since her 2015 surgery. The bleeding came after the Pfizer vaccine was administered.
CDC Split Type:

Write-up: First Pfizer Dose was administered to patient via right arm injection at 3:00pm on June 24,2021. Around 7pm same day patient began experiencing abnormal vaginal bleeding. The bleeding was about the same amount as the start of a menstrual cycle. Patient has not had a menstrual period since 2015 due to the surgical removal of all her reproductive organs including uterus , ovaries , fallopian tubes. Cervix was surgically stitched shut. Patient had to have her reproductive system removed due to a diagnosis of breast cancer back in 2013 to her left breast which required her to undergo chemo and hysterectomy of her breast and reproductive organs. Post vaccination patient abnormally experienced vaginal bleeding that cannot be explained being that she has no reproductive system. The bleeding lasted till next day.


VAERS ID: 1427654 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Deafness unilateral
SMQs:, Hearing impairment (narrow)

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

Write-up: Systemic: hearing loss in left ear <1 min after dose...see below-Mild, Additional Details: pt reported that immediately after dose <1 minute he experienced a decline in his hearing to the left ear. I called the patient this morning for follow up (06/25/2021 @ 10:05 am) and the patient reported that some of his hearing has returned, but is still "muffled". I asked the patient to report to his physician especially if the problem persists and/or gets worse. I also asked the pt to report any progression to me.


VAERS ID: 1427684 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Feeling cold, Feeling hot, Immediate post-injection reaction, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertraline, esomeprazole, risperidone, buspirone, pseudoephedrine
Current Illness:
Preexisting Conditions: Anxiety, depression, GERD
Allergies: carbapenems, sulfa antibiotics, macrolides
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient called at 145, states she got covid vaccine at 1250. She describes having dizziness, lightheadedness, and "feeling of overheating" that is continuing. She stated she had a little dizziness at time of vaccine but it has worsened after leaving. She is not driving (father is driving). I asked if there was any trouble breathing and she stated "a little". I advised to lie down and elevate feet, and remain in cool place. The patient stated the dizziness was worsening still. I advised to either go to the Emergency department/urgent care or return to pharmacy for us to monitor her. She will do one of the above. I spoke to patient about 237 pm, she ended up going to ER for observation, and is currently there being monitored. spoke to patient today 6/25/21, patient was in ER for a while but has been discharged. Pt states she was feeling hot for a while then later felt cold (could be because hospitals are cold). Patient states ER gave her a breathing treatment and something to relax the nerves (not sure of medication). She still has some dizziness and arm soreness but it has improved significantly since yesterday.


VAERS ID: 1427703 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

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

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

Write-up: Patient slumped over in chair was not feeling well and possible having trouble breathing. We called 911 and they came and checked her blood pressure and blood sugar. All were normal. Patient did not leave with the ambulance. She went home and ate something and was feeling much better.


VAERS ID: 1427772 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anxiety, Asthenia, Chest pain, Erythropsia, Eye movement disorder, Feeling abnormal, Restlessness, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Ocular motility 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:
Current Illness:
Preexisting Conditions: Intractable epilepsy without status epilepticus
Allergies:
Diagnostic Lab Data: None, did not stay in ED to be evaluated
CDC Split Type:

Write-up: After receiving the first Pfizer vaccine, the patient started to suspect that he was going to experience an epileptic event related to the vaccination administration. The patient screamed, and upon assessment the patient''s eyes were pointing up and I could see the whites of his eyes, and felt like he was going to vomit. The patient appeared to be oriented. The patient''s blood pressure and HR were taken, found to be within BP 133/90 HR at 124. The patient appeared anxious and said that he was "seeing red", and continued to appear restless. The patient stated "I am going to have an event" and "I think I''m having blurry vision". EMS called while this RN comforted the patient during this time and appeared to become calm. Prior to EMS arrived, the patient stated "My body is moving and I''m not doing anything". The patient was encouraged to lay down on the floor as he stated that he felt weak, stated he was having chest pain, and continued to experience intermittent blurry vision. EMS arrived at 1213 and he was assessed. EMS suggested that walking over to the emergency department,and the patient agreed. The patient and son were escorted to the ED triage desk by this RN via wheelchair. On arrival to ED Pt left stating "I feel better and I''m gong to eat some food and come back" Did not return


VAERS ID: 1427791 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 - / IM

Administered by: School       Purchased by: ?
Symptoms: Abdominal pain upper, Adverse reaction, Agitation, Anxiety, Cold sweat, Dizziness, Dyspnoea, Feeling cold, Formication, Hypoaesthesia, Nausea, Paraesthesia, Somnolence, Tremor
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient denies
Current Illness: Patient denies any
Preexisting Conditions: Patient denies history of health concerns
Allergies: Patient denies any known allergies
Diagnostic Lab Data: Further testing and laboratory results per hospital (transferred to the
CDC Split Type:

Write-up: Approximately 10-15min following vaccination, pt endorsed feeling dizziness, facial numbness and tingling (without weakness or pruritis), generalized tingling/"bug-crawling" sensation. This resolved within 5 minutes. Approx 30 minutes after vaccination, patient then endorsed dizziness, nausea, stomach cramping, became clammy/cool and was trembling, anxious-appearing then intermittently sleepy, with agitated/labored breathing. Pt was transferred to the ED by EMS. ED impression per ED report was vaccine reaction, anxiety reaction. Lower suspicion for anaphylaxis by initial clinic and ED evaluations.


VAERS ID: 1427804 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 already had a dose of Janssen and then was given a dose of Pfizer


VAERS ID: 1427818 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Feeling abnormal, Paraesthesia, Paraesthesia oral, Swollen tongue
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Dementia (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient called later in the afternoon of her COVID vaccination stating her lips and cheeks were feeling odd, which she described as a tingling feeling. She stated this started about an hour after her vaccine. She had access to benadryl but had not taken any at that point. She was advised to seek immediate medical attention if she started having any trouble breathing or her throat felt like it was closing up. We spoke to the patient a few hours later and she still had some tingling in her upper lip, but was feeling better than earlier. The next day, we followed up again and she had taken a dose of bendaryl the previous evening and she stated that her tongue is now feeling "thick", but her lips and cheeks were no longer tingling. She also said that she is not having any trouble breathing (and possibly thinking to much about vaccine) - but felt like she could not take as deep a breath as normal. She said she can perform all daily activities including exercising.


VAERS ID: 1427852 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-22
Onset:2021-06-24
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 2 LA / IM

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

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

Write-up: Started breaking out in rash on the torso approx 48 hours after admin that then moved to arms and legs during the day on 6/24/21 and then to face on 6/25/21. Treatment recommended: Benadryl, cortisone, and to check with primary care doctor if rash gets worse or if no improvement in 3-4 days


VAERS ID: 1427859 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-05
Onset:2021-06-24
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 - / IM

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

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

Write-up: myocarditis requiring care in pediatric ICU


VAERS ID: 1427912 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Private       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: AAA; PAIN IN RIGHT KNEE; VITAMIND DEFICIENCY; ORAL LESION; MICROSCOPIC HEMATURIA; HYPERTENSION; HEART MURMUR
Allergies: NKA
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: The expired vial was labeled as COVID 19 Vaccine / Janssen 0.5ml / EXP: 6/23/21 @ opened 2:15 This vial was used for a Veteran on 6/24/21 @ 1043


VAERS ID: 1427934 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U6828AA / 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: unknown
Current Illness: unknown
Preexisting Conditions: none
Allergies: nkda
Diagnostic Lab Data: na
CDC Split Type:

Write-up: Patient fainted after receiving the menactra vaccination


VAERS ID: 1427940 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Injection site swelling, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: None
Current Illness: None
Preexisting Conditions: N/A
Allergies: None
Diagnostic Lab Data: 6/24/21
CDC Split Type:

Write-up: Swollen at injection site, body aches, nausea, tired


VAERS ID: 1427968 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Chills, Feeling abnormal, Headache
SMQs:, Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: At 2 am i woke up with chest pains chills body aches bad headaches i never felt this bad in years


VAERS ID: 1427974 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperhidrosis, Loss of consciousness, Pallor, Tremor, 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), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: The patient calmly walked out to seating area and sat down after receiving vaccine. The patient did state that he "did not like needles". After a few minutes the patient went pale, started sweating, then lost consciousness for about a minute. During that time patient was unresponsive. No vitals were taken. I ran to get an Epipen and by the time I came back the patient was alert and responsive albeit a little shaky. Patient was given water, a small Cliff bar, and an orange soda. After about half an hour, the patient stated he was fine and left.


VAERS ID: 1427986 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None. Patient denied
Current Illness: None. Patient denied.
Preexisting Conditions: None. Patient denied.
Allergies: None. Patient denied.
Diagnostic Lab Data: Vital signs taken and seen above.
CDC Split Type:

Write-up: @1543 CW notified RN patient was c/o dizziness and headache while in monitoring area. Patient was vaccinated at 1540. @1545 RN placed patient in private room, attempted to lay in chair but patient refused. Water was provided to patient. @1546 Vital signs taken; BP: 165/103, P: 70, SPO2: 98%. MD was notified of patient. @1548 MD arrived to assess patient. Patient denied any more dizziness or headache and stated, ?I feel fine?. MD requested to lay patient and repeat vital signs. BP: 171/94, P: 96, SPO2: 99%, MD requested larger BP cuff for vital signs. @1550 MD took BP manually with a larger BP cuff, BP: 115/70. Per MD, patient is ok to go home. @1552 Patient was sat back up slowly in chair. Denied any dizziness or headache. Gave patient a few minutes in the sitting position before standing. Family member was at patient?s side. @1558 Patient stood up and stated, ?I feel fine, I?m ok to go?. Patient ambulated a steady gait and left the clinic in stable condition accompanied by family member.


VAERS ID: 1428011 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Mouth ulceration
SMQs:, Severe cutaneous adverse reactions (broad), Systemic lupus erythematosus (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 2 mouth ulcers on inner lower lip


VAERS ID: 1428046 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Discomfort, Feeling of body temperature change, Mobility decreased, Pain, Peripheral swelling, Pyrexia
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flonase
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Arm swelling, started to swell up early evening despite constantly moving it and massaging the shot site area. Fever came shortly thereafter, 99.9 then progressed higher throughout the night at 101.5. Body aches are immensely painful, hard to maneuver limbs. Also chills as my body has been constantly cold then hot. Extremely uncomfortable.


VAERS ID: 1428072 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol (PROVENTIL HFA;VENTOLIN HFA) 90 mcg/actuation inhaler cetirizine (ZyrTEC) 10 MG tablet ferrous sulfate 325 (65 FE) MG tablet fluticasone propionate (FLONASE) 50 mcg/actuation nasal spray 1 spray into each nostril 2
Current Illness: Migraines
Preexisting Conditions: Migraines, Asthma, Anemia, Seasonal Allergies
Allergies: PCN
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient began to notice her arm was extremely heavy, red, and swollen approx. 27 hours after the vaccination. Ice and Ibuprofen were used to control the swelling and discomfort.


VAERS ID: 1428090 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-03
Onset:2021-06-24
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid 25 mcg,vit d3, vit b12, fanotiden, panropelze, Celexa 40mg, magnesium 100mg, vit c 1000mg
Current Illness: None
Preexisting Conditions: Hashimotos deiease
Allergies: Z-pak, penicillin, fast food
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever after 12 hours and chill, 24 hrs alot worse


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