Found 28,192 cases where Vaccine is COVID19 or COVID19-2 and Vaccination Date from '2023-01-01' to '2023-12-31'

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

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

Write-up: Patient was administer bivalent dose in error. He still needs to complete the primary series.

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heart rate increased, Hypertension, Palpitations, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypertension (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: Palpitation through out the body, increased heart beat, rash on her face Given Diphenhydramine 25 mg. Checked blood pressure and it was high 148, and 160 then went down to 128. Patient said she did not feel palpitation anymore after 10-15 min. Patient was told to monitor blood pressure at home and would feel drowsy due to allergy medication. She was sent to home with her son.

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: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: patient was given bivalent dose when they were expecting first dose in the series.

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

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

Write-up: Client and family came by to receive the Bi-valent booster made by Moderna. They received the mono-valent booster in error. The family has been notified, and advised about potential adverse reactions such as a sore arm in the morning. The family was also advised to wait 2 months before getting the bivalent booster in accordance with current recommendations. The family members seemed frustrated, but understanding and appreciative of the pharmacy?s openness with them regarding the situation. Contributing factors include high volume, similarities between the two packages, improper workflow by the pharmacist, and storage of the two similar medications directly next to each other.

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

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

Write-up: Client and family came by to receive the Bi-valent booster made by Moderna. They received the mono-valent booster in error. The family has been notified, and advised about potential adverse reactions such as a sore arm in the morning. The family was also advised to wait 2 months before getting the bivalent booster in accordance with current recommendations. The family members seemed frustrated, but understanding and appreciative of the pharmacy?s openness with them regarding the situation. Contributing factors include high volume, similarities between the two packages, improper workflow by the pharmacist, and storage of the two similar medications directly next to each other.

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

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

Write-up: Client and family came by to receive the Bi-valent booster made by Moderna. They received the mono-valent booster in error. The family has been notified, and advised about potential adverse reactions such as a sore arm in the morning. The family was also advised to wait 2 months before getting the bivalent booster in accordance with current recommendations. The family members seemed frustrated, but understanding and appreciative of the pharmacy?s openness with them regarding the situation. Contributing factors include high volume, similarities between the two packages, improper workflow by the pharmacist, and storage of the two similar medications directly next to each other.

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

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

Write-up: Client and family came by to receive the Bi-valent booster made by Moderna. They received the mono-valent booster in error. The family has been notified, and advised about potential adverse reactions such as a sore arm in the morning. The family was also advised to wait 2 months before getting the bivalent booster in accordance with current recommendations. The family members seemed frustrated, but understanding and appreciative of the pharmacy?s openness with them regarding the situation. Contributing factors include high volume, similarities between the two packages, improper workflow by the pharmacist, and storage of the two similar medications directly next to each other.

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? 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 Moderna Bivalent booster instead of Moderna (primary series) for second dose. Called patient to notify of mix up and patient came back to get Moderna second dose.

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? 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 came in to get Moderna Primary series (first dose), but technican gave Moderna Bivalent booster .

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

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

Write-up: Pt did not think that he had the pfizer bivalent booster yet- did not think he had his vaccine card with him. Said that his last vaccine was over 2 months ago and that it was Pfizer but the first 2 vaccine he got were Moderna. Vaccine given, then patient found documentation stating that he had the pfizer bivalent booster already exactly 2 months ago. Informed pt that he got an additional dose of the bivalent booster when it was not needed and gave him documentation to take home with him stating that he got that vaccine at my clinic given by me on todays date.

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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT RECEIVED THE ORIGINAL PFIZER MONO VALENT INSTEAD OF THE PFIZER BIVALENT DUE TO MY ERROR , PATIENT WILL HAVE TO RETURN TO US FOR ANOTHER VACCINE IN 2 MONTHS

Administered by: Public       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: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: Zofran
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: This child was given Pfizer Bivalent 12 and up dose (0.3ml) instead of Pfizer Bivalent 5-11 years (0.2ml)

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

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

Write-up: Pt did not have an adverse event. However, pt presented for the newest Covid Booster. After giving pt Pfizer bivalent she presented cards that showed she already received Covid bivalent on 09/20/22 from her Dr. office. So pt accidently received a 2nd Pfizer bivalent booster dose.

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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: thyroid np/levothyroxine
Current Illness: cough reported 12/19 per medication history; visit to urgent care
Preexisting Conditions: hypothyroidism
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: PER PATINET, AWOKE OVERNIGHT WITH HEART PALPITATIONS/MILD CHEST PAIN THAT HAS CONTINUED TO PRESENT TIME

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

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

Write-up: N/A

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

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

Write-up: Patient received second bivalent booster

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: Both patients (twin brothers) were given the pfizer bivalent (gray cap) instead of the pediatric version. They are 11 years and 3 months but not old enough to receive this vaccine yet. Upon speaking to the mother the following day, the patients both are doing fine and not experiencing any side effects from their vaccination.

Administered by: Public       Purchased by: ?
Symptoms: Extra 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: None
Current Illness:
Preexisting Conditions: N/A
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient received an extra dose of the Pfizer Bivalent Booster. Her original Bivalent was given on 10/4/2022 but was not entered on her CDC card

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
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: UNKNOWN
CDC Split Type:

Write-up: PATIENT BEGAN TO PASS OUT AND IT IS AMBIGUOUS IF HE PASSED OUT OR HAD A MINOR SEIZURE.

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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none reported on var
Current Illness: none reported on var
Preexisting Conditions: none reported on var
Allergies: none reported on var
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt reeived the bivalent covid vaccine in error. patient came to pharmacy for primary series dose#1

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

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

Write-up: passed out after vaccinations were administered. regained consciousness after approximately 1 minute

Administered by: Unknown       Purchased by: ?
Symptoms: Immediate post-injection reaction, Muscular weakness, Nausea, Paraesthesia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)

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

Write-up: Almost immediately after given vaccine client began to feel nausea, tingling in both arms and weakness, client placed in anti-gravity chair and water client began to feel better.

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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient was given a vaccine that was over 24 hours in room temperature. The advised temperature is no more than 12 hours in room temperature

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: None
Current Illness: None
Preexisting Conditions: None
Allergies: Thimerosol, sulfa
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient was given vaccine that was over 24 hours in room temperature. Patient will follow up with primary care doctor.

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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: NO APPARENT ADVERSE REACTION, BIVALENT VACCINE ADMINISTERED FOR DOSE 1 INSTEAD OF MONOVALENT VACCINE.

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

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

Write-up: Patient mother reports headache , nausea and vommiting. Patient advised to maintain hydration. Acetominophen for headaches.

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

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

Write-up: Developed fever 12 hours after vaccination, then significant bodyaches all over 24 hours later. Fever resolved after 48 hours, but bodyaches still persisting after 48 hours.

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

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

Write-up: No adverse reactions noted - Vaccines BUD date was 12/28/2022 - Vaccine given on 01/03/2023 5 days past BUD date

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Dysgeusia, Eye irritation, Lacrimation increased, Nausea, Pharyngeal swelling, Swelling, Swelling face, Swollen tongue
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Corneal disorders (broad), Vestibular disorders (broad), Lacrimal disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Na
Current Illness: Na
Preexisting Conditions: Na
Allergies: Penicillin
Diagnostic Lab Data: I am going in to urgent care now.
CDC Split Type:

Write-up: Within 15 minutes of receiving the COVID19 Pfizer vaccination, I began feeling a swollen feeling near my left carotid artery, and it began radiating out through the left side of my face. My throat and tongue now feels swollen, and my eyes are burning and watery. I have a metalic taste in my mouth, and as of the last 5 minutes (2:41 pm) feel lightheaded and slightly nauseous.

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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Bivalent booster was given for 1st dose in primary series

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

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

Write-up: Brief Description Patient presents to clinic to receive second dose Pfizer Covid 19 vaccine, parent present.. Parent provided Covid 19 Vaccination Record Card that showed 1st dose Pfizer was given. Parent requesting second dose of Pfizer Covid 19 vaccine. Upon documentation, it was discovered that patient had received second dose of Pfizer Covid 19 vaccine. Parent advised that patient had received second dose in the past. Parent continued to deny vaccine was given. Parent requesting for Covid 19 Pfizer second dose to be given today..

Administered by: Public       Purchased by: ?
Symptoms: Extra 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: n/a
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: Rice and Chocolate concentrate
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented, accompanied by parent, for Second dose Pfizer COVID 19 vaccine. Parent presented vaccination card with only first dose vaccine administration. Parent stated patient had not received her second dose COVID 19 vaccine and denied ever receiving second dose COVID 19 vaccine. Parent advised of previously administered second dose COVID 19 vaccine. Parent continued to deny second dose COVID 19 vaccine was administered and continued requesting second dose COVID 19 vaccine to be administered on 1/03/23.

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dose administered, Product preparation issue
SMQs:, Medication errors (narrow)

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

Write-up: Vial of Covid 19 6m-4yr vaccine was not diluted with sodium chloride and all 10 doses were given to the patient in one injection.

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dose administered, Product preparation issue
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: Hand Foot and Mouth (B08.4) 11/20/2022
Preexisting Conditions: NONE
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vial of Covid 19 6m-4yr vaccine was not diluted with sodium chloride and all 10 doses were given to the patient in one injection.

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure increased, Dizziness, Heart rate increased, Laboratory test, Muscular weakness, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: Leukemia
Allergies: codeine, Vicodin, ciprofloxacin, hydrocodone, lactulose, Latex
Diagnostic Lab Data: Lab work was done at local hospital unknown results at this time
CDC Split Type:

Write-up: Patient experienced weakened muscles, rapid heart rate, elevated blood pressure, dizziness, nausea

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dose administered, Product preparation issue
SMQs:, Medication errors (narrow)

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

Write-up: Vial of Covid 19 6m-4yr vaccine was not diluted with sodium chloride and all 10 doses were given to the patient in one injection.

Administered by: Public       Purchased by: ?
Symptoms: Incorrect product formulation 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: Not known
Current Illness: NA
Preexisting Conditions: NA
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient did not have any adverse reactions to vaccine.

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin Centrum Silver Duloxetine Metformin Rosuvastatin Calcium solifenacin succinate Tramadol
Current Illness: None
Preexisting Conditions: Hypertension Type 2 diabetes mellitus Fatty Liver
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient received COVID Booster, Pf Bivalent Booster, instead of 2nd dose of Pfizer vaccine in initial series. Patient did not exhibit adverse reaction and no treatment needed.

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

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

Write-up: The Patient was unintentionally provided an expired dose of this vaccine. The patient had no symptoms or adverse reactions. The patient was notified of the error and plans to return in 8 weeks to be revaccinated per CDC and the manufacturer guidelines.

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Eliquis Atorvastatin Cyanocobalamin Lisinopril Meclizine Metoprolol tartrate omeprazole paroxetine polyethylene glycol promethazine tramadol
Current Illness: None
Preexisting Conditions: Hypertension Obstructive sleep apnea Reflux esophagitis Chronic Kidney Disease
Allergies: Amlodipine Besylate
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient was administered Bivalent booster instead of 1st dose of COVID vaccine in initial series.

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

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

Write-up: No adverse reactions. Patient received pfizer booster bivalent on 1/3/23, 3rd dose, however it was beyond use date. Placed in fridge on 10/17/22, beyond use on 12/26/22.

Administered by: Pharmacy       Purchased by: ?
Symptoms: Atrial fibrillation, Condition aggravated
SMQs:, Supraventricular tachyarrhythmias (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: Atrial Fibrillation. Lasted about a couple hours, needed to take medication. Had not had an episode in several months and was feeding good.

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dose administered, Product preparation issue
SMQs:, Medication errors (narrow)

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

Write-up: The nurse administered the Bivalent COVID vaccine without first diluting it.

Administered by: Private       Purchased by: ?
Symptoms: Underdose
SMQs:, Medication errors (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: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna infant dose was given to 54 yo patient

Administered by: Private       Purchased by: ?
Symptoms: Headache, Immunisation reaction, 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: no known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pfizer bivalent 12 and up was administered to 9 year old in error. Dose administered was 0.2ml. Parent notified, child had normal expected reaction following vaccine. 01/04/2023 child had mild headache. Also received influenza vaccine same day.

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered, Fatigue, Injection site reaction, Malaise
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 received an expired pfizer bivalent dose (Beyond used date: 12/27/2022; administered on 01/02/2023). Spoke to patient''s mother and she said patient feels Injection site reactions, tired, and overall malaise.

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: I was informed by the MA administering the vaccine that she did not dilute the vaccine prior to vaccination. No known adverse effects at this time. Patient''s mother was notified about error. She is going to keep an eye on the patient and will present to ER if any symptoms occur and will follow up with doctor.

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CALCIUM, ESTRADIOL, HYDROXYCHLOROQUINE, JARDIANCE, LORATADINE, MUTLIVITAMIN, ROSUVASTATIN, SYNTHROID, TYLENOL ARTHRITIS
Current Illness: NONE
Preexisting Conditions:
Allergies: FLAGYL
Diagnostic Lab Data: NOTHING PATIENT IS FINE
CDC Split Type:

Write-up: PATIENT RECEIVED BIVALENT BOOSTER DOSE 1/3/2023 - HOWEVER WHEN SHE GOT HOME SHE HAD CARD THAT SHE HAD ALREADY GOTTEN DOSE ON 11/3/2022 WHICH WAS NEVER DOCUMENTED IN MEDICAL RECORD OR UPLOADED TO LOCAL CENTER. IMAGE FOUND AFTER PHONE CALL. PATIENT GOT TWO BIVALENT DOSES 2 MONTHS APART.

Administered by: Private       Purchased by: ?
Symptoms: Inappropriate schedule of product administration
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: MS
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine given 1 day early, earliest due was 1/5/23 and vaccine was given 1/4/23.

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

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

Write-up: WAS ADMINISTERED 1ML INSTEAD OF 0.5ML

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none per patient, but reports she has had some issues with anesthesia in the past.
Diagnostic Lab Data: none
CDC Split Type:

Write-up: patch of hives on right lower face and on left bend of arm immediately after injection. No shortness of breath, dizziness, or any other symptoms. monitored patient for 30 minutes after.

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: poly trim drops
Current Illness: none
Preexisting Conditions: prematurity 29 weeks
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: The patient received the 5 -11 year old COVID 19 Pfizer vaccine instead of the 6 months - 4years vaccine

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

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

Write-up: Patient received Pfizer Bivalent vaccine in October of this 2022 and scheduled another dose today 01/04/2023. We missed the previous dose and administered a second dose of Bivalent vaccine today.

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

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

Write-up: patient was given the 5 - 11 year COVID 19 vaccine and should have received the 6 months - 4 years vaccine

Administered by: Private       Purchased by: ?
Symptoms: Interchange of vaccine products, No adverse event
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: No adverse effects.
CDC Split Type:

Write-up: Wrong manufacturer given. This child should have received the Moderna Bivalent booster but was given the Pfizer Bivalent 3rd dose. This child got the Moderna 1st and 2nd dose primary series.

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

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

Write-up: Pt was given monovalent instead of bivalent as a booster.

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

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

Write-up: Pt was given monovalent instead of bivalent booster shot

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

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

Write-up: Patient was given monovalent instead of bivalent booster shot

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

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

Write-up: Gave patient monovalent booster instead of bivalent booster.

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

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

Write-up: PAIENT REPORTED THAT HER ARM (AROUND THE SITE OF INJECTION) WAS SWOLLEN, RED AND WARM TO THE TOUCH. SHE RECEIVED HER MODERNA BIVALENT COVID VACCINE BOOSTER 2 DAYS AGO AND HER SYMPTOM BEGAN THE MORNING AFTER AND HAD INCREASED IN AREA ON THE SECOND DAY. THE AREA APPEARED INFLAMMED ABOUT 2.5 INCHES X 2.5INCHES. PT WAS ADVISED TO CONTACT HER HEALTHCARE PROVIDER TO GET IT EVALUATED AND TO GO TO THE ER IF IT WORSENS. THE INFLAMMATION APPEARED LIKE A "COVID ARM" AND SHE WAS ALSO ADVISED IN THE MEANTIME TO APPLY COLD COMPRESS AND TAKE SOME TYLENOL FOR PAIN RELIEF.

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20236

Write-up: rash on the abdomen and chest; This spontaneous case was reported by a physician and describes the occurrence of RASH (rash on the abdomen and chest) in an infant female patient who received mRNA-1273 BIVALENT .222 (MODERNA COVID-19 VACCINE, BIVALENT (ORIGINAL AND OMICRON BA.4/BA.5)) (batch no. 215K22A) for COVID-19 prophylaxis. Previously administered products included for COVID-19 prophylaxis: Moderna COVID-19 Vaccine on 24-Jun-2022 and Moderna COVID-19 Vaccine on 29-Jul-2022. Past adverse reactions to the above products included No adverse event with Moderna COVID-19 Vaccine and Moderna COVID-19 Vaccine. On 02-Jan-2023 at 5:03 PM, the patient received dose of mRNA-1273 BIVALENT .222 (MODERNA COVID-19 VACCINE, BIVALENT (ORIGINAL AND OMICRON BA.4/BA.5)) (unknown route) 1 dosage form. On an unknown date, the patient experienced RASH (rash on the abdomen and chest). At the time of the report, RASH (rash on the abdomen and chest) had not resolved. For mRNA-1273 BIVALENT .222 (MODERNA COVID-19 VACCINE, BIVALENT (ORIGINAL AND OMICRON BA.4/BA.5)) (Unknown), the reporter did not provide any causality assessments. Patient did not received any other vaccines in the 4 weeks prior to COVID-19 vaccine. The parent reported a rash on the abdomen and chest starting 4 hours after the vaccine administration. Concomitant medication was not provided. Treatment medication information was not provided by the reporter.

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

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

Write-up: Patient was due to 3rd dose of COVID 19 vaccination. Consent and screening completed per mom. Pfizer COVID 19 Bivalent 12+ was ordered and RN gave Pfizer COVID 19 Monovalent 12+. Patient, parent, physician, and management notified of error. Patient waited in office 15 minutes after administration of vaccination with no adverse effects.

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Sexual dysfunction (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: nexium
Current Illness: none
Preexisting Conditions: none known.
Allergies: nka
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient had brusing and numbness in there entire arm for days.

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown; patient does not regularly fill at our pharmacy
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Phenazopyridine
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient''s husband called 1/5/23 to report the patient had broken out in hives after receiving the Pfizer Bivalent Covid booster vaccine. I counseled him to give the patient two 25 mg Benadryl tablets to alleviate the hives and to go the the emergency room if symptoms worsen.

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

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

Write-up: 2nd dose of Pfizer was given one day early

Administered by: Private       Purchased by: ?
Symptoms: Product preparation 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: None
Current Illness: None
Preexisting Conditions: GERD
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was administered undiluted Pfizer 6mo-4yr Bivalent vaccine and was noticed after family left the office. Staff notified Supervisor. Pfizer contacted. Dr. will be contacting family today to notify them of incident.

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

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

Write-up: Patient came into the office with parent for 2nd dose of Peds Pfizer Vaccine, CVPP and I pulled the wrong vaccine, CVPO and administered to patient in the right deltoid which is the Peds Pfizer Bivalent dose; we do not have in stock; I immediately reported to my Nurse Manager, spoke with parent about vaccine error; obtained V/S normal (P94, R18, BP 112/78; T98, O2 98%); monitored patient for an hour; no distress noted; no S/S of any adverse effects; no swelling noted; no SOB; denies pain at site at this time; patient is alert/oriented; smiling, talking with her parents, and playing on her mobile device; parent verbalized understanding; I advised parent/patient someone will be in touch with her within 24 hours for follow up with the child

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None noted
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: Patient was counseled and kept in the office for a longer observation period.
CDC Split Type:

Write-up: Patient was given a 2.5ml dose instead of a 0.5ml dose of the Moderna bivalent covid booster.

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

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

Write-up: *Dose #1 Moderna Monovalent covid vaccine given at 10:46 am in left deltoid.Pt waited 15 minutes for observation; no problems noted. When he got up to leave, he fell on the floor. Pt stated no apparent injuries, but he felt dizzy. Pt denies having breakfast this morning. Pt able to ambulate with assistance; placed on stretcher. VS monitored for 1 hour by RN. At 10:55 am, bp=128/70, HR=80, Pulse ox=100%, skin cool and damp. At 11:15 am, BP=130/80, HR=86, Pulse ox=98%. Pt stated he felt much better, head of stretcher elevated.At 11:30am, BP=128/76, HR=76. Laughing, talkiing, skin is dry, denies discomfort.at 11:55 am, BP=127/72, HR=76. * Plan: Plan Pt left for home with wife; ambulatory. Denies dizziness or any symptoms. Advised to contact his PCP for any further concerns.

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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Asthma
Allergies: None
Diagnostic Lab Data: None
CDC Split Type: