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From the 2/23/2024 release of VAERS data:

Found 574 cases where Vaccine is COVID19 and FLUC4

Government Disclaimer on use of this data

Table

   
Event Outcome Count Percent
Death 6 1.05%
Life Threatening 9 1.57%
Permanent Disability 8 1.39%
Birth Defect 1 0.17%
Hospitalized 33 5.75%
Emergency Doctor/Room 65 11.32%
Office Visit 101 17.6%
Recovered 256 44.6%
None of the Above 203 35.37%
TOTAL † 682 † 118.82%
† Because VAERS cases can have multiple vaccinations, symptoms, and event outcomes, a single case can account for multiple entries in this table. This is why the Total Count is greater than 574 (the number of cases found), and the Total Percent is greater than 100.



Case Details (Sorted by State)

VAERS ID: 2597666 (history)  
Form: Version 2.0  
Age: 3.0  
Sex: Female  
Location: Unknown  
Vaccinated: 2023-03-14
Onset: 2023-03-14
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FX5095 / 1 RL / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 353556 / 1 LL / IM

Administered by: Private       Purchased by: ?
Symptoms: Expired product administered, 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: Vaccine administration error: COVID 19 vaccination was given 90 days past removal from deep freeze, which is 20 days past the "beyond-use" date of 2/22/23. No symptoms. No treatment. Decision when to re-vaccinate was made in cooperation with parent of patient.


VAERS ID: 2687541 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated: 2023-09-19
Onset: 2023-09-20
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HH7595 / 1 RA / OT
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944458 / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Photosensitivity reaction, Vaccination site pain, Vomiting
SMQs:, Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202300307737

Write-up: 24 hours after administration the patient developed dizziness, lightheaded, photosensitivity, arm pain around injection site, and vomiting.; 24 hours after administration the patient developed dizziness, lightheaded, photosensitivity, arm pain around injection site, and vomiting.; 24 hours after administration the patient developed dizziness, lightheaded, photosensitivity, arm pain around injection site, and vomiting.; 24 hours after administration the patient developed dizziness, lightheaded, photosensitivity, arm pain around injection site, and vomiting.; This is a spontaneous report received from non-contactable reporter (Pharmacist). A 42-year-old male patient received bnt162b2 omi xbb.1.5 (COMIRNATY (2023-2024 FORMULA)), on 19Sep2023 at 11:00 as dose 1, single (Lot number: HH7595) intramuscular, in right arm for covid-19 immunisation; influenza vaccine inact sag 4v (FLUCELVAX QUAD), on 19Sep2023 as dose 1, single (Lot number: 944458), in right arm for immunisation. The patient''s relevant medical history and concomitant medications were not reported. The following information was reported: VOMITING (non-serious), DIZZINESS (non-serious), PHOTOSENSITIVITY REACTION (non-serious), VACCINATION SITE PAIN (non-serious) all with onset 20Sep2023 at 08:00, outcome "recovered" and all described as "24 hours after administration the patient developed dizziness, lightheaded, photosensitivity, arm pain around injection site, and vomiting.". Therapeutic measures were not taken as a result of vomiting, dizziness, photosensitivity reaction, vaccination site pain. Additional information: Prior to vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient has not been tested for COVID-19.


VAERS ID: 2072469 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Unknown  
Vaccinated: 2021-10-24
Onset: 2021-12-27
   Days after vaccination: 64
Submitted: 0000-00-00
Entered: 2022-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / N/A LA / ID

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Fatigue, Malaise, Respiratory tract congestion, SARS-CoV-2 test positive, Upper-airway cough syndrome
SMQs:, Anaphylactic reaction (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Positive Covid test after a few days of symptoms: fatigue, congestion, cough/post nasal drip. Sick for about 5 or 6 days. Used albuterol to help with cough.


VAERS ID: 1836643 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Unknown  
Vaccinated: 2021-11-01
Onset: 2021-11-01
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049E21A / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308486 / 1 RA / 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Booster dose. Vaccine administered on 11/01/21. Vial expired 10/11/21. Vial was kept in freezer until 10/30/2021 and removed to fridge on 10/30/2021 for administration on 11/01/2021.


VAERS ID: 2037962 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Unknown  
Vaccinated: 2022-01-15
Onset: 2022-01-15
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3139 / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308945 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness transient, Deafness, Dizziness, Loss of consciousness, Throat tightness
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, arterial (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Patient reported blacking out, temporary vision/hearing loss, dizziness, and throat felt tight Black out phase lasted roughly 5 minutes until patient showed improvement and progressively had no symptoms anymore after 30 minutes


VAERS ID: 2696543 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated: 0000-00-00
Onset: 0000-00-00
Submitted: 0000-00-00
Entered: 2023-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3030335 / UNK - / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / UNK - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Injection site pain, Injection site swelling, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (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: Similar reactions to previous Moderna vaccines
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chills, fever, body ache continuing for 24+ hours. Mild pain and swelling at injection site


VAERS ID: 2696855 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Unknown  
Vaccinated: 2023-10-02
Onset: 2023-10-02
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AU3914B / 4 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. AU3128B / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Limb discomfort
SMQs:

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

Write-up: Patient called reporting to technician on 10/16/23, stating she feels like her arm is "broken" and is alleging tissue damage from a vaccine. She states she is going to have an MRI done.


VAERS ID: 2645498 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Unknown  
Vaccinated: 2023-06-13
Onset: 2023-06-14
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 4 RA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 12/09/2021 - flu vaccine and Pfizer COVID booster at the same time. Feverish. Congestion. Fatigue
Other Medications: Lactaid, generic Zyrtec
Current Illness:
Preexisting Conditions:
Allergies: Apples, peaches, soy milk, kiwi, cats, dust, pollen
Diagnostic Lab Data:
CDC Split Type:

Write-up: Round and bumpy swelling around injection site for the flu vaccination. Hives growing at the nape of the neck. Right arm had no swelling. Over time swelling in left arm went down. Took 50mg of Benadryl.


VAERS ID: 2022453 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Unknown  
Vaccinated: 2021-11-11
Onset: 2021-11-22
   Days after vaccination: 11
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Erythema, Mechanical urticaria, Pruritus, Rash macular, SARS-CoV-2 test negative, Swelling, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Birth control pill (vestura) Escitalopram (Lexapro) 5mg
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Sulfa drugs Amoxicillin Cefzil
Diagnostic Lab Data:
CDC Split Type:

Write-up: About 11 days after getting the Moderna booster and seasonal flu shot, I developed hives (urticaria) beginning on my scalp and moving to my shoulders and then my entire body. After 2 days, I went to urgent treatment clinic to seek relief from itching and swelling. I was prescribed prednisone for 5 days, which helped slightly but it was clear that it did not cure the hives. After these 5 days, I used Benadryl and Claritin, as directed by the urgent treatment clinic doctor, to relieve symptoms for about 5 weeks. The patches (that started out seemingly randomly and blotchy or circular) turned to looking more dermographism (skin writing) after about a week. Anywhere I touched my own skin would become itchy, red, and raised. It took about 6 weeks to go away significantly. Between 11/22/21 and 1/4/22, I?ve tested negative for covid 4 times on both rapid and PCR tests.


VAERS ID: 2623655 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Unknown  
Vaccinated: 2022-11-25
Onset: 2022-11-30
   Days after vaccination: 5
Submitted: 0000-00-00
Entered: 2023-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 5 - / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 - / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Balance disorder, Electric shock sensation, Hypoaesthesia, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: PRN symptoms. Tingling, Numbness, small fiber electric shock, weakness, balance in feet.


VAERS ID: 2014248 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Unknown  
Vaccinated: 2021-11-05
Onset: 2021-11-16
   Days after vaccination: 11
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 3 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308429 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fall, Femur fracture, Hip surgery
SMQs:, Accidents and injuries (narrow), Osteoporosis/osteopenia (broad), Osteonecrosis (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, 16 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fall with hip surgery, ED visit and hospital admissions. Closed nondisplaced subtrochanteric fracture of right femur with routine healing. this visit was within 6 weeks of receiving the COVID vaccine.


VAERS ID: 2701659 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Unknown  
Vaccinated: 2023-10-21
Onset: 2023-10-21
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HG4633 / UNK - / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370673 / UNK - / -

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

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

Write-up: Patient recieved two vaccines Flucelvax and Comirnaty (one in each arm) was sat down and waited 10 minutes before getting up, got up and fainted and fell and hit there head. Patient did report that they have had nausea/ trouble with vaccines in the past. They were checked out by paramedics and released without further care needed.


VAERS ID: 2711271 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Unknown  
Vaccinated: 2023-11-07
Onset: 2023-11-07
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 210F232A / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944496 / N/A RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Dizziness, Face injury, Fall, Haemorrhage, Scratch
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Patient walked to another aisle shortly after receiving her vaccines; as she walked back to sit down, patient felt lightheaded, fell, and hit her face on the floor. Her chin was slightly bleeding and scraped. Blood pressure was normal. Patient had an anxiety attack during the incident. EMT were called, they applied Neosporin and butterfly bandage on her chin. No hospitalization needed. Mom came by to pick up patient home.


VAERS ID: 2540715 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Unknown  
Vaccinated: 2022-12-20
Onset: 2022-12-01
Submitted: 0000-00-00
Entered: 2022-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019H22A / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 352490 / UNK RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blood lactic acid, Dizziness, Hypotension, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Dizziness, fever, hypotension, lactic acid 4.2


VAERS ID: 1942417 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Unknown  
Vaccinated: 2021-12-11
Onset: 2021-12-11
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308485 / UNK RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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 began to feel ill a few minutes after vaccines and began vomiting


VAERS ID: 2720975 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Female  
Location: Unknown  
Vaccinated: 2023-10-26
Onset: 2023-10-26
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Incorrect dose administered, Product label 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna vaccine administration needed. Provider ordered 0.25mL to be administered. Vaccine obtained from Moderna vial that stated "single dose vial containing 0.25mL" Administered total volume present in vial, approximately 0.5mL, without knowledge that there was extra volume in the vial


VAERS ID: 2720976 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Male  
Location: Unknown  
Vaccinated: 2023-10-20
Onset: 2023-10-20
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AU5509B / UNK - / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Incorrect dose administered, Product label 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna vaccine administration needed. Provider ordered 0.25mL to be administered. Vaccine obtained from Moderna vial that stated "single dose vial containing 0.25mL" Administered total volume present in vial, approximately 0.5mL, without knowledge that there was extra volume in the vial


VAERS ID: 2720969 (history)  
Form: Version 2.0  
Age: 4.0  
Sex: Female  
Location: Unknown  
Vaccinated: 2023-11-07
Onset: 2023-11-07
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AU5509B / UNK - / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Incorrect dose administered, Product label 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna vaccine administration needed. Provider ordered 0.25mL to be administered. Vaccine obtained from Moderna vial that stated "single dose vial containing 0.25mL" Administered total volume present in vial, approximately 0.5mL, without knowledge that there was extra volume in the vial


VAERS ID: 2720977 (history)  
Form: Version 2.0  
Age: 4.0  
Sex: Female  
Location: Unknown  
Vaccinated: 2023-10-20
Onset: 2023-10-20
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK - / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (PRIORIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Incorrect dose administered, Product label 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna vaccine administration needed. Provider ordered 0.25mL to be administered. Vaccine obtained from Moderna vial that stated "single dose vial containing 0.25mL" Administered total volume present in vial, approximately 0.5mL, without knowledge that there was extra volume in the vial


VAERS ID: 2720978 (history)  
Form: Version 2.0  
Age: 4.0  
Sex: Male  
Location: Unknown  
Vaccinated: 2023-11-02
Onset: 2023-11-02
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AU5509B / UNK - / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Incorrect dose administered, Product label 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna vaccine administration needed. Provider ordered 0.25mL to be administered. Vaccine obtained from Moderna vial that stated "single dose vial containing 0.25mL" Administered total volume present in vial, approximately 0.5mL, without knowledge that there was extra volume in the vial


VAERS ID: 1925287 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Unknown  
Vaccinated: 2021-12-04
Onset: 2021-12-04
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / N/A AR / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / N/A AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Generalised tonic-clonic seizure, Loss of consciousness
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), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Approximately two and a half hours after vaccinations patient reported feeling light headed and dizzy before having a grand mal seizure. This prolonged for an unknown amount of time before she regained consciousness and was evaluated by paramedics. While advised to visit a doctor no follow up was taken.


VAERS ID: 2720968 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Male  
Location: Unknown  
Vaccinated: 2023-10-30
Onset: 2023-10-30
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Incorrect dose administered, Product label 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna vaccine administration needed. Provider ordered 0.25mL to be administered. Vaccine obtained from Moderna vial that stated "single dose vial containing 0.25mL" Administered total volume present in vial, approximately 0.5mL, without knowledge that there was extra volume in the vial


VAERS ID: 2729855 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Unknown  
Vaccinated: 2024-01-02
Onset: 2024-01-03
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2024-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 5 - / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Chills, Erythema, Fatigue, Headache, Injection site pain, Pain, Pain in extremity, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tamiflu a couple days prior to vaccination
Current Illness: exposure to influenza, no symptoms.
Preexisting Conditions: question of oral allergy syndrome.
Allergies: tree nuts, shellfish, apple, pear, peach, cherry.
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Received flu and COVID vaccine on 1/2/24. Followed with general body aches, chills, fatigue, headache, pain at the site of injection treated with advil and tylenol with some improvement. Now with residual arm pain. Also C/o rash in face as red ovals like hives yesterday worse in face and neck also rest of body, treated with banedryl with resolution over following hours. NO rash today.


VAERS ID: 2715480 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Unknown  
Vaccinated: 2023-11-13
Onset: 2023-11-13
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 4 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 7+ LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Hypotension, Immediate post-injection reaction, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: syncope, low BP


VAERS ID: 1968196 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Unknown  
Vaccinated: 2021-12-20
Onset: 2021-12-20
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1855191 / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308460 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure decreased, Dizziness, Somnolence, Vision blurred
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Patient came to pharmacy to get Janssen booster and Flucelvax vaccine. After receiving both vaccine, a provider recommended patient to sit down for 15 min. Patient looked normal and she had no sign of reaction. Patient started feeling dizziness in about 1 min, she sat down and her eyes had blurry vision. BP was 64/44 and we tried to keep her stay awake while calling 911. She could answer questions while provider asked her. She felt better when paramedic arrived.


VAERS ID: 2518310 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Unknown  
Vaccinated: 2022-10-07
Onset: 2022-10-07
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 4 LA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Dysmenorrhoea, Headache, Heavy menstrual bleeding, Pain, Pyrexia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), 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: Similar reaction to previous Covid vaccines
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, headache, chills, aches within 24 hours of receiving vaccines. Very strong cramps and heavy flow two following menstrual cycles after vaccination (about 2 and 6 weeks after vaccination).


VAERS ID: 1970404 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Male  
Location: Alaska  
Vaccinated: 2021-12-21
Onset: 2021-12-21
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL8095 / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308477 / N/A RA / IM

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

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

Write-up: A technician administered the flu and covid vaccines, then walked back to the pharmacy. About a minute later someone in the lobby reported an emergency, I (pharmacist) went to the lobby area to see the matter. Patient was on the floor and appeared to be waking up, his mother stated she thought he had convulsed then fainted. Patient stated he had difficulty breathing and was very pale, I administered 10mL of benadryl 12.5mg/5mL solution. Patient reported nausea and prepared to vomit, but he did not vomit. I stayed with patient to monitor him for changes while his mother called 911, patient stated he did not feel better or worse. EMS arrived shortly after and took over care. Patient''s family refused transport to hospital via EMS but did say they would drive to the hospital afterward. Of note, patient''s mother stated he had not had a reaction to a vaccine like this in the past, including the flu vaccine.


VAERS ID: 2024632 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Alabama  
Vaccinated: 2022-01-09
Onset: 2022-01-10
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2022-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013H21A / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308469 / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Neck pain, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient experienced redness and soreness in arm that extended down the arm and up into the neck.


VAERS ID: 2019387 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Alabama  
Vaccinated: 2022-01-07
Onset: 2022-01-07
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 059H21A / 3 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 70461032103 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Blood blister, Bone pain, Dizziness, Headache, Injection site erythema, Injection site pain, Injection site swelling, Lip swelling, Nasopharyngitis, Pelvic pain, Peripheral swelling, Pyrexia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Osteonecrosis (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (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: Swollen lymph nodes, red swollen painful injection site, headache, dizziness, heart palpitations, severely swollen arm, febrile
Other Medications: Bisoprolol, zyrtec d, zinc, vitamin c, vitamin d3, lexapro,
Current Illness:
Preexisting Conditions:
Allergies: Cipro, hydrocodone, feldene, latex, pineapple, banana
Diagnostic Lab Data:
CDC Split Type:

Write-up: Red swollen painful feverish injection site. Febrile 100.0, dizziness, headache, severe bone pain worse in the lower back and pelvic region. Cold like symptoms and swollen lips with blood blisters. Also right arm is swollen from shoulder to elbow


VAERS ID: 2745770 (history)  
Form: Version 2.0  
Age: 1.33  
Sex: Female  
Location: Alabama  
Vaccinated: 2024-02-05
Onset: 2024-02-05
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2024-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HH3252 / N/A LL / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 371204 / N/A RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. X011082 / 4 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UJ964AD / 4 LL / IM

Administered by: Private       Purchased by: ?
Symptoms: Body temperature increased, Wrong product administered
SMQs:, Neuroleptic malignant syndrome (broad), Medication errors (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: NKDA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Medical assistant accidentally administered Hep B vaccine instead of Hep A vaccine. Pt''s mom was notified once the error was noted. Pt''s mom said that Pt slept a bit longer for her nap after the vaccines were administered and had a low grade temp, but otherwise was feeling fine. No signs or symptoms noted.


VAERS ID: 2696230 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Alabama  
Vaccinated: 2023-10-13
Onset: 2023-10-13
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3030366 / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 94449 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Flushing, Hyperhidrosis, Hyporesponsive to stimuli, Loss of consciousness, Moaning, Pain, Presyncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NA patient does not wish to disclose.
Current Illness: N/A
Preexisting Conditions: Patient does not wish to disclose.
Allergies: Codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was very nervous to get the vaccines and she stated she did not like shots. She was seated. She received both shots as indicated above and shortly about 1 minute after her face became red, she was sweating, and she was flushed. After that point, she seemed to pass out for a short period but was moaning and was semi-responsive. We fanned patient and she came back around after maybe a minute of this seemingly vaso vagal reaction. She was given juice and upon asking her she told me she had not ate very much that day. This is the second patient I have had that has ate very little or not at all that has gone vaso vagal with two vaccines. Not sure if there is a correlation with sugar levels and getting vaccinations that result in a vagovasal response. Patient was fine afterwards. Refused EMS. Waited for 10 minutes before leaving. Her mom was by her side and mentioned she passed out with giving blood before but never with vaccines. Called patient 10/14/2023 evening time and she is doing fine other than having body soreness but her mom has same symtpoms and she got the same vaccines as said patient at the same time.


VAERS ID: 1793836 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Alabama  
Vaccinated: 2021-10-11
Onset: 2021-10-12
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308476 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Extra dose administered, Interchange of vaccine products, Pain, Wrong product administered
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), 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 known
Current Illness: no chronic illnesses reported at time of administration
Preexisting Conditions: none reported to pharmacy
Allergies: no allergies reported
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient was administered Pfizer''s vaccine as a 3rd COVID19 vaccine after receiving 2 previous doses of moderna vaccine on 3/25/21 and 4/24/2021 when requested to receive a flu shot. She stated for the next 2 days she felt dizzy and sore but felt better when we spoke on Thursday October 14th.


VAERS ID: 2483010 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Arkansas  
Vaccinated: 2022-10-17
Onset: 2022-10-17
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FP7138 / 4 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. AS1593B / UNK RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Simethicone and Famotidine
Current Illness: stomach ache, diarrhea, gas, bloating, abdominal pain, abdominal distention, UTI
Preexisting Conditions: Anxiety, insomnia, plantar fasciitis, bilateral
Allergies: Aspirin and PNC
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: No symptoms or adverse events have occurred at this time.


VAERS ID: 2483061 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Arkansas  
Vaccinated: 2022-10-17
Onset: 2022-10-17
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FP7138 / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. AS1593B / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect product formulation administered, No adverse event, Pregnancy test negative
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: Albuterol Nebulizer solution, Albuterol HFA, Bupropion HCL ER, Celexa, and Singulair
Current Illness: None on day of visit
Preexisting Conditions: Asthma and anxiety
Allergies: NKDA
Diagnostic Lab Data: Pregnancy test done in clinic- negative 10/17/2022
CDC Split Type:

Write-up: Patient needed the bivalent dose of Pfizer, but received regular Pfizer, no adverse event or occurrences needed/noted.


VAERS ID: 2483077 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Arkansas  
Vaccinated: 2022-10-18
Onset: 2022-10-18
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FP7138 / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. AS1593B / UNK RA / IM

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: Aspirin, Atorvastatin, B12 folate, Flonase, lisinopril, loratadine, meloxicam, and sertraline
Current Illness: None at time of visit
Preexisting Conditions: Hypertension, Hyperlipidemia, anxiety, chronic pain, seasonal allergies
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient needed the bivalent dose of Pfizer, but received regular Pfizer, no adverse event or occurrences needed/noted.


VAERS ID: 1754736 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Arkansas  
Vaccinated: 2021-09-30
Onset: 2021-09-30
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308467 / N/A RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Electrocardiogram, Eructation, Erythema, Gait disturbance, Nausea, Oropharyngeal discomfort, Throat clearing, Urine analysis
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), 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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Symbicort 160mcg/4.5mcg (Inhale 2 puffs by mouth into the lungs twice a day); Spironolactone 50mg (Take 1 tablet by mouth once daily); Diltiazem ER 300mg (Take 1 capsule by mouth once daily); Cyclobenzaprine 10mg (PRN - Take 1 tablet by mou
Current Illness: Treated for severe constipation (had taken magnesium citrate and a Fleet saline enema one day prior to vaccination)
Preexisting Conditions: 1) Asthma (severe); 2) Fibromyalgia; 3) Tachycardia; 4) Hypertension; 5) Generalized Anxiety Disorder; 6) Depression
Allergies: Levaquin (levofloxacin) (hives); sulfa drugs (Stevens-Johnson Syndrome); penicillin (large doses result in heart palpitations and chest pain); oxycodone (rash); CT dye (syncope); prenatal vitamins (hives); latex (rash)
Diagnostic Lab Data: Patient reported tests at the hospital included: EKG; urinalysis; blood panel, oxygen by nasal cannula; chest X-ray Patient also reported being sent home with a 5-day course of steroids (Prednisone 40mg - once daily)
CDC Split Type:

Write-up: Patient presented for vaccination at an on-site, employer sponsored wellness event around 1500 on September 30, 2021. After providing consent for vaccination and pharmacist evaluation of suitability as a candidate for vaccination, patient was administered a flu vaccine and COVID vaccine. Approximately 10 minutes after vaccination (1510), patient returned to the vaccination area with complaints of an enlarging, reddened area on the right arm, but did not appear in any distress and denied difficulty breathing or symptoms or airway swelling. Pharmacy personnel provided the patient with Benadryl 75mg (dose per patient request per her past routine with other allergic reactions) and Famotidine 20mg to be taken orally. She then returned to her work area just down the hall from the vaccination clinic. Approximately 8 minutes later (1518), one of the patient''s co-workers presented to the vaccination clinic area with a request to assist the patient, as the patient was attempting to proceed back to the clinic area but was having difficulty (walking). A pharmacist proceeded a short distance down the hallway and found the patient sitting upright on her own power in a chair in the hallway. The patient had complaints of nausea and a "dry" pharangeal area which "didn''t feel right" (she has since stated that it felt like she needed to clear her throat and couldn''t). Her right arm was erythematous but not swollen, and her feet bilaterally were appearing mildly erythematous. Due to these symptoms, the pharmacist determined that dosing with an Epipen was warranted. Per physician-signed pharmacy protocol and with the patient''s knowledge and consent, the patient was administered epinephrine 0.3mg via auto-injector into the lateral aspect of the left thigh at 1520, and emergency personnel were immediately summoned. The patient''s blood pressure and pulse were checked with a manual sphygmomanometer with the patient still in a seated position at 1523 and 1527, with readings of 145/90, pulse=110 and 135/85, pulse=108 respectively. The patient was nauseated during this time period, had frequent belching, but no emesis noted. While a third blood pressure and pulse were being attempted at 1532, emergency personnel arrived on the scene and took over care. A report of all medications and care administered were given to ambulance personnel, as well as a copy of the immunization consent form (including vaccines administered). Patient was transported to hospital for further evaluation and management.


VAERS ID: 2483114 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Arkansas  
Vaccinated: 2022-10-18
Onset: 2022-10-18
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FP7138 / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. AS1593B / UNK LA / IM

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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin, atorvastatin, cetirizine, Flonase, hydrocodone-acet, omeprazole, Tylenol, and Viagra
Current Illness: Mole to chest
Preexisting Conditions: GERD, erectile dysfunction, seasonal allergies, coronary artery calcification, hyperlipidemia, pulmonary nodule, prostate cancer, fatty liver
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient needed the bivalent dose of Pfizer, but received regular Pfizer, no adverse event or occurrences needed/noted.


VAERS ID: 2483124 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Arkansas  
Vaccinated: 2022-10-18
Onset: 2022-10-18
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FP7138 / UNK RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. AS1593B / UNK RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: carvedilol, Cymbalta, entresto, gabapentin, lutein, medical cannabis, pantoprazole, praluent, sotalol, trazadone, vitamin B, vitamin C, vitamin D, voltern gel, vraylar, Xanax, zinc
Current Illness: None
Preexisting Conditions: fibromyalgia, GERD, bipolar, dyslipidemia, hyperlipidemia, hypertension, urinary incontinence, chronic pain, fatty liver
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient needed the bivalent dose of Pfizer, but received regular Pfizer, no adverse event or occurrences needed/noted.


VAERS ID: 1802188 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Arizona  
Vaccinated: 2021-10-05
Onset: 2021-10-08
   Days after vaccination: 3
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH WAG3767 / 3 LA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Chest discomfort, Computerised tomogram thorax, Cough, Discomfort, Dyspnoea, Headache, Myalgia, Pain in extremity, Ultrasound scan
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Bupropion, Emgality, Cal Carb/Mag/Zinc Oxide, Budesonide EC, Omega-3, Lyrica, Metaxalone, Centrum Silver Women?s, Vitamin B-12, Pantoprazole, Vitamin D2, Topiramate, Lidoderm patch
Current Illness: None
Preexisting Conditions: Fibromyalgia, Acoustic Neuroma, Psoriatic Arthritis
Allergies: NKDA NKFA
Diagnostic Lab Data: Monday 10/11/21. CT scan of Chest & Ultrasound of Right leg.
CDC Split Type:

Write-up: SOB, Chest Tightness, Muscle Pain, Cough, Right Leg Pain, Headache (HA onset of vaccination), and elevated Blood Pressure. Within 3 days of the vaccine I was having a lot of trouble breathing and Days 5 & 6 were the worst. Unable to lay on back to sleep which started three days after receiving the vaccine, or I feel uncomfortable and it?s difficult to breathe. On Day 6 I went to the Emergency Room with all symptoms and they were unable to determine the exact cause of the elevated blood pressure and SOB, suggesting to follow up with a Cardiologist.


VAERS ID: 2603796 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Arizona  
Vaccinated: 2022-11-04
Onset: 2022-11-04
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014H22A / 4 AR / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / N/A AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Cytokine storm, Dizziness, Dyschezia, Fatigue, Fear, Immune system disorder, Impaired work ability, Malaise, Mobility decreased, Muscle disorder, Oedema peripheral, Renal pain, Swelling, Ultrasound scan, X-ray
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific dysfunction (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Tendinopathies and ligament disorders (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: same adverses but not as intense 12/19/2021
Other Medications: none
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: all NSAIDs.
Diagnostic Lab Data: 11-16-2022 I went to urologist to check my kidneys. 11-23-2022 I went to my primary care doctor for the pains, swelling. 02-14-2023 I went to get the right underarm that''s still swollen, x-rayed and ultrasounded.
CDC Split Type:

Write-up: Within 10 mins of vaccines: Dizziness Weakness / fatigue chills next day Sat 2022-11-05: initially took my temp 98.5F , while I?m usually low 97F. Fever. Severe kidney pains on both kidneys, despite drinking lots of water & resting lots; urinating as normal, so severe it almost called for an ambulance/emergency. I just pained through it barely. I could barely get out of bed. My friend stated that it was an ?aggressive immune response?, my immune system attacking itself which is deadly, ?Cytokine storm? which is fatal / organ failure. This was very scary and I don''t want to die over a vaccine. In the future, I don''t think it''s the best idea for me to get these types of vaccines. For at least 2 months following, lots of swelling and muscles out of sorts. I had a very difficult time passing bowel movements, but now I am back to normal. Still to this day Mar-2023, my right underarm front area is slightly swollen, specifically from 2 COVID vaccines. Since the 11-04-2022 vaccines here, I have spent money in follow up doctor bills to check if my organs / body will be okay from this terrible ordeal. Plus having to take time off work; and losing time that I can''t gain back from being so sick. In my case, the cost to my body outweighed the benefits to getting the vaccines. My body cannot tolerate the COVID vaccine.


VAERS ID: 2019711 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Arizona  
Vaccinated: 2022-01-07
Onset: 2022-01-08
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2022-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 2 LA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Disorientation, Dizziness, Loss of consciousness, Ocular hyperaemia, Pyrexia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None known
Diagnostic Lab Data: We monitored patient closely all day and he seemed alert and felt normal (the mild fever went away and did not return as well). We did not seek medical care.
CDC Split Type:

Write-up: Patient was getting a haircut when he slumped over in the chair and passed out unconscious for 15-20 seconds. When he came to, his eyes were blood shot and he was disoriented (not sure what happened). He said that he suddenly became dizzy before blacking out. This is the first time patient has ever blacked out. He had eaten a large meal roughly 2-3 hours prior to the event and was adequately hydrated (did not appear to be a blood sugar or hydration issue). A few hours later he seemed to be running a mild fever and was given 200mg ibuprofen. Otherwise he was fine the rest of the day.


VAERS ID: 2705745 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Arizona  
Vaccinated: 2023-10-23
Onset: 2023-10-24
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-10-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 6 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angioedema, Diarrhoea, Dysphonia, Erythema, Paraesthesia, Pharyngeal swelling, Speech disorder
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Dementia (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Spiriva 125mcg - 2 inhalations daily, clarinix 5mg daily, propranolol 10mg daily, wellbutrin XL 150mg daily, synthroid 25mcg daily, docusate 100mg 1-2xdaily, lisinopril 2.5mg daily, famotidine 20mg QHS, montelukast 10mg QHS, atorvastatin 40
Current Illness: Bone marrow biopsy 10/16/2023 to r/o cancer, PET scan 10/17/2023 (lung nodule 0.5cm and 1.5cm spleen lesion), CKD stage 3a
Preexisting Conditions: CKD stage 3a, asthma, allergies, common variable immune deficiency, hormone replacement, GERD
Allergies: sulfa, triamcinolone, percocet, tramadol, codeine, chocolate, sesame
Diagnostic Lab Data: epinephrine x2 doses IM, solumedrol 125mg IV, benadryl 50mg IV, famotidine 20mg IV, 1L normal saline 0.9%
CDC Split Type:

Write-up: returned from lunch at approx 1410 and at approx 1430 developed symptoms of anaphylactic reaction: angioedema (lips and slight eyes) throat swelling to include change in voice and ability to speak, red and tingly palms, diarrhea


VAERS ID: 2526805 (history)  
Form: Version 2.0  
Age: 1.5  
Sex: Male  
Location: Arizona  
Vaccinated: 2022-12-07
Onset: 2022-12-08
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2022-12-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AS141B / UNK RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 348359 / UNK LA / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 94H52 / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Capillary nail refill test, Pallor, Pruritus, Pyrexia, Rash, Rash erythematous, Rash macular, Rash papular, Respiratory pathogen panel, Viral rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypotonic-hyporesponsive episode (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: acetaminophen for fever
Current Illness: Had vomited x 1 day prior to vaccination
Preexisting Conditions: none
Allergies: none known
Diagnostic Lab Data: 12/8/22: Biofire NP swab: negative for all 23 pathogens tested.
CDC Split Type:

Write-up: Pt brought in by mom and grma. A few red dots noticed on arms and face at bedtime on 11/7/22. Woke with much more rash in AM of 12/8/22, with most dense rash on face. No new known evironmental exposures. Pt with pruritis of scalp and posterior neck. No SOB, no lip swelling, no diarrhea. Tactile fevers at home. Temp 99.0F here in clinic. On exam he is scratching his scalp. No facial swelling. Mucous membrans moist. Lungs clear, no wheezing. Heart RRR w/o murmurs. Cap refill < 1 sec. Injection sites on deltoids w/o redness, tenderness or swelling. Starting in the upper leg and groin area he has a blanching macular papular red slightly raised rash that becomes more confluent the closer you get to his scalp and face where it is mostly confluent. No vesicles or ulcers. No petechiae. Pt had a Biofire nasopharyngeal swab done and was prescribed oral diphenhydramine for the pruritis and acetaminophen suppositories to replace the liquid form with f/u as needed. Despite the negative NP swab I do think it is more likely this is a viral exanthem rash, but because I can''t find a pathogen, I am reporting this to VAERS.


VAERS ID: 2483905 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Arizona  
Vaccinated: 2022-10-18
Onset: 2022-10-18
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AS7163B / 5 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 348372 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT GIVEN 2ND DOSE OF BIVALENT VACCINE. PT HAD PFIZER BIVALENT ON 09/21/22 THAN GIVEN MODERNA BIVALENT ON 10/18/22. PT DID NOT HAVE COVID CARD NOR DID HE REMEMBER HE WAS GIVEN BIVALENT 4 WEEKS EARLIER. ERROR FOUND ON CHARTING VACCINE. NO ADVERSE EVENT


VAERS ID: 2713712 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Arizona  
Vaccinated: 2023-11-12
Onset: 2023-11-12
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 209F23A / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944494 / UNK LA / IM

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

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

Write-up: Patient stated before vaccine that she has a history of fainting after all vaccines. She did become pale and fainted after 2nd vaccine (flu) and continued to take deep breaths and was leaning on friend next to her. She did vomit after a few deep breaths and said she was ok just needed a few minutes to recover. She has a cold compress of her head and some water and was feeling better after a few minutes. After she was feeling better and left the vaccine room she waited in the store for an additional 15 min for observation.


VAERS ID: 2730811 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Arizona  
Vaccinated: 2024-01-05
Onset: 2024-01-01
Submitted: 0000-00-00
Entered: 2024-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (NOVAVAX)) / NOVAVAX 5683MF012 / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944499 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abortion spontaneous, Exposure during pregnancy, Pregnancy
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (narrow), Normal pregnancy conditions and outcomes (narrow)

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

Write-up: Positive pregnancy tests on 1/4, 1/5, and 1/8. Vaccine administered on 1/5. Miscarriage started 1/9. Est due date was 09/14.


VAERS ID: 2716011 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Arizona  
Vaccinated: 2023-11-14
Onset: 2023-11-14
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HG4633 / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944478 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising, Injection site haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: patient denied illnesses
Preexisting Conditions: Hypertension, hyperlipidemia, hypothyroidism per medication list
Allergies: Patient reported no known allergies.
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient bled after the vaccine and a bruise was visible right away within a minute, Pt stayed for 15 min after the vaccine and reported brief pain down the elbow after the shot, pain did not reoccur. The injection site was elevated, patient was advised to ice the injection site, and went home. Pt reported the swelling went down within an hour after icing. Injection site was still bruised on 11/20/2023. Patient denied limited range of motion, or pain.


VAERS ID: 1693099 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Arizona  
Vaccinated: 2021-09-09
Onset: 2021-09-10
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308451 / N/A RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Induration, Pain, Swelling
SMQs:, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Red, swollen bump, hard, painful


VAERS ID: 2694183 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: California  
Vaccinated: 2023-10-11
Onset: 2023-10-11
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3030535 / N/A LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944460 / N/A RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: After a Moderna vaccine, patient "felt hot" a few days after receiving the vaccine in a similar manner. No faintness or nausea o
Other Medications: Insulin, Crestor
Current Illness: Diabetes
Preexisting Conditions: Diabetes
Allergies: NKDA
Diagnostic Lab Data: N/a
CDC Split Type:

Write-up: About 5 minutes after receiving vaccine, patient felt very hot, faint, nauseated, and had to lie down to keep from passing out. Patient did not pass out. Patient felt better after about 10 minutes.


VAERS ID: 2057662 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Male  
Location: California  
Vaccinated: 2022-01-22
Onset: 2022-01-22
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308497 / UNK RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anxiety, Asthenia, Headache, Immediate post-injection reaction, Malaise, Pallor
SMQs:, Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Client does not take any medications.
Current Illness:
Preexisting Conditions: No chronic medical conditions.
Allergies: No food or medication allergies only has mild allergies to dust.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client received his first dose of COVID vaccine and the Flu vaccine today (Pfizer Pediatric COVID vaccine lot: FL0007 exp: 03/16/22 on his left arm and the Flucelvax lot: 308497 exp: 06/30/22 on his right arm). Ancillary approached EMT table asking for water and snack, because client was not feeling well. EMT came over to the client and started doing the assessment. EMT noted upon assessment that client''s skin was pale, client appeared weak and client was leaning forward and clutching his head. Client reported that he had a headache with a 4/10 pain scale that happened immediately after the last vaccine was administered. The last vaccine administered was the Flucelvax. EMT escorted client to the gravity chair by the observation area. Client was able to ambulate without any assistance. EMT obtained first set of vitals at 11:04 AM: Blood pressure: 94/76, Pulse Rate: 86, Respiration Rate: 16 and Oxygen Saturation: 98% and gave the client water. Upon sitting on the gravity chair and drinking water client verbalized, "I feel better." RN and EMT assisted with tending to client. Client''s father reported that client has no chronic medical history, he''s not taking any medications and only has mild allergies to dust. Father informed EMT that client does get anxious in situations like these. Client completed 30 minutes observation with no other reactions. Second set of vitals was obtained at 11:37 AM: Blood pressure: 94/72, Pulse Rate: 78, Respiration Rate: 16 and Oxygen Saturation 100%. Client''s father reported that client does look better. RN educated client''s father on ER precautions and when to follow up with the Pediatrician. Client left the facility with his family and ambulated without any assistance at 11:38 AM.


VAERS ID: 2161948 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: California  
Vaccinated: 2022-02-17
Onset: 2022-02-17
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045L21A / 3 - / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308431 / UNK - / SYR

Administered by: Unknown       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: The vaccine this patient received was determined to have had a temperature excursion below the recommended storage temperature prior to administration. There was no recommendation to repeat the dose from the vaccine manufacturer.


VAERS ID: 2714349 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: California  
Vaccinated: 2023-11-08
Onset: 2023-11-08
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HG9498 / 4 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 374409 / 2 RA / IM

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

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

Write-up: none


VAERS ID: 2715038 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: California  
Vaccinated: 2023-11-10
Onset: 2023-11-11
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 5 - / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Nausea, Palpitations
SMQs:, Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Anxiety, diagnosis 2020, managed with lexapro for one year and counseling; Currently counseling only
Preexisting Conditions: Anxiety
Allergies: Penicillin: Hives
Diagnostic Lab Data: Pending Holter monitoring and EKG
CDC Split Type:

Write-up: Presents to clinic for palpitations, nausea the morning after the vaccines. Recommend EKG at urgent care and Holter monitoring with primary care physician.


VAERS ID: 2411161 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: California  
Vaccinated: 2022-08-12
Onset: 2022-08-12
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FP7150 / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 942379 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Eye movement disorder, Syncope, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Ocular motility disorders (narrow), 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: n/a
CDC Split Type:

Write-up: Eyes rolled back, shaking, fainted for 5 seconds, regained consciousness, and was confused on what happened


VAERS ID: 2715554 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: California  
Vaccinated: 2023-11-19
Onset: 2023-11-19
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HG9498 / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944481 / UNK RA / IM

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

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

Write-up: Patient was sitting in waiting room after she received the 2 vaccines. Shortly after, patient''s friend screamed for help bc patient fainted. I rushed out; patient was conscious again by the time I got to patient. Pt denied SOB . Just the tips of her fingers were slightly tingling, but resolved shortly after. Patient denied for us to call the ambulance. Drank water and waited until she felt better and back to " normal" before she left.


VAERS ID: 2715781 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: California  
Vaccinated: 2023-11-20
Onset: 2023-11-20
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HG2282 / N/A LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944466 / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood gases, Cyanosis, Electrocardiogram, Immediate post-injection reaction, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: penicillin
Diagnostic Lab Data: BG, O2 sat, EKG, others unknown (performed by EMS 11/20/2023)
CDC Split Type:

Write-up: Patient received both flu and COVID (Pfizer) vaccines by the nurse while seated in the immunization at approximately 10:30am. Soon after receiving both vaccines, the patient immediately fainted while seated and started turning pale and lips were turning purple. I was not aware of this until I was flagged by the pharmacy cashier to go into the immunization room to triage the situation. After being informed that the patient fainted, I had the patient elevate her legs. I proceeded to call 9-1-1. During the call, the patient started feeling better. I insisted that EMS take a look at the patient and let them decide if they should head to the hospital for further evaluation. EMS arrived around 10:40am and evaluate the patient. 10 minutes after evaluation, EMS reported the vitals were within normal limits, but recommended that the patient go to the hospital. The parent of the patient refused transport to the hospital. EMS left, and then after that the family left without further incident. Per the parent, this is the first time the patient has ever fainted from a vaccination. This was likely a vasovagal response. Will note this incident within patient profile.


VAERS ID: 2695347 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: California  
Vaccinated: 2023-10-11
Onset: 2023-10-11
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HG4659 / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 94465 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Exposure during pregnancy, Eyelid margin crusting, Lacrimation increased, Ocular hyperaemia
SMQs:, Anaphylactic reaction (broad), Glaucoma (broad), Lacrimal disorders (narrow), Periorbital and eyelid disorders (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: enoxaparin 40 mg/0.4 ml,
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient is a 6 1/2 weeks pregnant. She came in to get her covid and flu vaccine. She called to say that 5 hours after receiving the vaccine she started noticing her left eye (which was the side that she received her vaccines) was watering. This morning she woke up to some crustiness in her eye and her eye was red. She said it looked like conjunctivitis. For now patient was advised to monitor. Told patient if it gets worse or if vision becomes blurry to get it checked out. Also if it doesn''t go away in a couple days she should get it checked out.


VAERS ID: 2058071 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: California  
Vaccinated: 2022-01-20
Onset: 2022-01-20
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL8095 / 2 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308497 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Fatigue, Pain in extremity
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Tendinopathies and ligament 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: Unknown
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: The client was accompanied by her mother and father. Client reported feeling dizzy to RN. Client ambulated and sat down in the anti-gravity chair. The anti-gravity chair was adjusted to a low fowler''s position. Lead RNs responded. The following was obtained with RN translating between Spanish and English. Vitals obtained at 03:42PM were as follows: HR 85, O2 97%. The client''s parents denied any chronic conditions or known allergies. The client denied any other symptoms. The client was provided a juice and crackers and began eating the crackers and drinking the juice. Vitals obtained at 03:44PM were as follows: BP 100/73. The client denied any dizziness, nausea or shortness of breath. The client reported arm pain in the right arm where she received the Flucelvax Quadrivalent vaccine. The anti-gravity chair was adjusted to a high fowler''s position. The client denied any dizziness. The client ambulated unassisted with a steady gait to the observation area at 3:48PM and sat down in the anti-gravity chair in a high fowler''s position. Vitals obtained at 3:52PM were as follows: BP 109/72, O2 98%, HR 89. The client denied any symptoms. RN provided education regarding possible adverse events and when to seek care. The client and her mother voiced understanding of this education. Repeat vitals obtained at 4:04PM were as follows: BP 105/71, HR 80, O2 99%. The client reported feeling tired but denied any other symptoms. The client ambulated unassisted with a steady gait out of the vaccination site at 4:11 PM.


VAERS ID: 2464961 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: California  
Vaccinated: 2022-09-06
Onset: 2022-09-16
   Days after vaccination: 10
Submitted: 0000-00-00
Entered: 2022-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AS714OC / 4 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 942390 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Injection site pain, Poor quality sleep
SMQs:, Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (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: I had similar chest pain in July 2021 (age 25) following the second does of the Moderna COVID vaccine on May 16, 2021. I visited
Other Medications: Vitamin D supplements
Current Illness: None
Preexisting Conditions: Headaches
Allergies: Amoxicillin and latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pain at the injection site for the first couple of days which affected my sleep quality. Slight chest pain starting September 16 that lasted until September 22. On September 22, I saw a doctor virtually and they advised me to avoid intense exercise, take over the counter pain killers like advil, and monitor symptoms but didn''t prescribe me any medicine.


VAERS ID: 2155985 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: California  
Vaccinated: 2022-02-17
Onset: 2022-02-17
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045L21A / 3 - / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308431 / UNK - / SYR

Administered by: Unknown       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: "The vaccine this patient received was determined to have had a temperature excursion below the recommended storage temperature prior to administration. There was no guidance to repeat the dose from the vaccine manufacturer."


VAERS ID: 2716012 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: California  
Vaccinated: 2023-11-17
Onset: 2023-11-20
   Days after vaccination: 3
Submitted: 0000-00-00
Entered: 2023-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 8057965 / 3 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944487 / 1 RA / IM

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

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

Write-up: Menstruation on day 3 after vaccination


VAERS ID: 2691737 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: California  
Vaccinated: 2023-10-04
Onset: 2023-10-04
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HG4628 / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 374409 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Amnesia, Crying, Dyskinesia, Impaired work ability, Laboratory test, Loss of consciousness, Seizure like phenomena, 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), Dementia (broad), Convulsions (narrow), Dyskinesia (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Did not got the chance to asked the EMT but they did some tests to her in Consultation room.
CDC Split Type:

Write-up: After I gave the flu shot, I told the patient you are all set, but not responding to me so when I checked her she was not responding.Patient became unconscious for 5 seconds or less, had jerking movement like having a seizure. Eyes still open though. Then suddenly woke up did not recalled what happened so we told her she was unconscious for awhile then afterwards she cried realizing what happened to her. Called the Mom and I asked if she ate anything then told us nothing to eat did not even drink water that morning. We told the Mom will call 911 just to be sure although they said she was fine. After maybe 10 minutes or less the EMT arrived and checked her said she was fine but continue to observe her at home and will not go to work that day.


VAERS ID: 2689084 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: California  
Vaccinated: 2023-09-24
Onset: 2023-09-25
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3030371 / UNK RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944447 / UNK RA / IM
RSV: RSV (AREXVY) / GLAXOSMITHKLINE BIOLOGICALS EP5FD / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Back pain, Chills, Gait inability, Headache, Hyperhidrosis, Muscular weakness, Nausea, Pain, Pain in extremity, Pyrexia, Renal pain, Spinal pain, Urinary incontinence, Vision blurred, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ondansetron 4 mg disintegrating tablet Commonly known as: ZOFRAN ODT Take 1 tablet (4 mg total) by mouth every 8 (eight) hours if needed for nausea or vomiting tiZANidine 4 mg tablet Commonly known as: ZANAFLEX Take 1 tablet (4 mg total)
Current Illness: Diabetes, Hypothyroidism, Hypertention, Chronic Migraine
Preexisting Conditions: Diabetes, Hypothyroidism, Hypertention, Chronic Migraine
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Began Monday 9/25/23 @2am The worst symptom was the weakness. I was too weak to walk. I thought I would fall. My legs would not hold me up much. I used a bedside portable toilet I had from my total knee replacement. There was pain in my lower back. It felt like my kidneys. It radiated down my legs and up my spine. If we use 0-10 as the pain scale it would have been a 10. I had blurry vision. When I was able to walk again on Tuesday I was incontinent of urine. I suppose the headache was to be expected (I''ve never had one this bad from a vaccine), fever (101), chills, vomiting, nausea, etc. Event resolved Tuesday evening @7pm I broke into a sweat and began to feel better.


VAERS ID: 2110829 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: California  
Vaccinated: 2022-01-13
Onset: 2022-01-13
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3209 / 3 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site mass, Injection site pain, Injection site pruritus
SMQs:, Extravasation events (injections, infusions and implants) (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: Flonase nasal spray
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A.
CDC Split Type:

Write-up: Patient developed right arm lump where she received the Flucelvax and COVID-19 vaccine. It has been painful and itching since day of administration (approximately 1 month at this point).


VAERS ID: 2440039 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: California  
Vaccinated: 2022-09-10
Onset: 2022-09-10
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FP7141 / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 942378 / N/A RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Seizure
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Patient appeared to be having a seizure for a short time (estimated to be less than a minute) after receiving his vaccines. The adverse event happened about a minute after receiving the vaccines. Upon awakening the patient felt normal other than having a small headache and possibly some difficulty breathing. Paramedics arrived and the patient''s mother elected to have him taken to the ER for more evaluation.


VAERS ID: 2689073 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: California  
Vaccinated: 2023-09-30
Onset: 2023-09-30
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HG4677 / 5 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 374409 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose normal, Dizziness, Hyperhidrosis, Pallor, Sinus arrhythmia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Disorders of sinus node function (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Pulse OX 98 BP 110/72 Blood glucose 86 sinus arrhythmia
CDC Split Type:

Write-up: Patient fainted on her way to the car. She was dizzy, pale, and sweating. This happened around 10 minutes after she received both shots. Mother was recommended to stay for 15 minutes, but her daughter never had adverse reaction in the past and both left right after.


VAERS ID: 2466927 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: California  
Vaccinated: 2022-09-12
Onset: 2022-09-13
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2022-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 5 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Grip strength decreased, Incorrect dose administered, Injection site bruising, Injection site discharge, Injection site pain, Loss of personal independence in daily activities, Mobility decreased, Pain, Pain in extremity, Sleep disorder
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Dementia (broad), Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad), 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: Vitamin D-3, 2000IU Hair Skin Nails Gummies Advanced, 6000mcg
Current Illness: no prior illness
Preexisting Conditions: no chronic conditions
Allergies: Tramadol - ringing in ears Vicodin - vomiting
Diagnostic Lab Data: no lab tests
CDC Split Type:

Write-up: The day after both vaccines were injected in my LEFT arm, I have had (nerve?) pain at my elbow. It radiates to my hand/fingers. I have much difficulty with movement, grabbing objects/lifting objects, and dull constant pain when not doing these activities. Sleeping is difficult as I wake up in pain while shifting in bed. This pain is constant and makes everything (daily activities) more difficult. There was no injury sustained at my elbow prior to, or after, injection The person injected both vaccines in LEFT arm (one appears to have gone into a muscle other than the deltoid, as she decided to inject lower on my arm - halfway between shoulder & elbow...the other one was 1-2" above this site. When injection took place in this area she told me my arm "spit" out the vaccine. No pain out of the ordinary at time of injection. I took picture of bruise on my arm of lower injection site (9/13/22).


VAERS ID: 2135192 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: California  
Vaccinated: 2022-02-23
Onset: 2022-02-23
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK9896 / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308497 / N/A RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: The patient said he was not taking any medications
Current Illness: The patient said he had "AIDS" and "shell shock."
Preexisting Conditions: The patient said he had "AIDS" and "shell shock."
Allergies: The patient denies a history of allergies.
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Patient received the Pfizer vaccine lot # FK9896 Beyond Usage Date 03/31/2022 on 02/23/2022 at 1050am and the Flucelvax vaccine lot# 308497 exp 06/30/2022 at 1054am. The client denied a history of allergies. He reported a history of ?AIDS? and said he had ?shell shock.? At 1103am the client said, ?I feel dizzy.? RN gave the client a juice and retrieved the yoga matt for the client to lie down on while RN assisted the client to put his head down between his legs until the matt was available. At 1104 am, RN helped the client lay down flat on the yoga mat while RN prepared to take the client''s vital signs. The RR was 18 and unlabored and his pulse was regular per palpation. The client refused to allow RN or other RN to complete his vital signs. At 1108 am, he said he felt ?all better.? He denied any lasting feelings of dizziness and sat up on a chair independently. He refused vitals while in a sitting position also. At 1109am he said he felt fine and told RN and another RN that he was leaving and then proceeded to stand up and walk away independently with a steady gait. RN educated the client about normal vaccine side effects and told him to seek care if his dizziness returned.


VAERS ID: 2010480 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: California  
Vaccinated: 2022-01-05
Onset: 2022-01-05
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3198 / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308496 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Discomfort, Erythema, Feeling hot, Pruritus, 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa Drugs and Ampicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Client presented to the vaccine site with her mother and received her COVID vaccine Pfizer Booster (lot #FL3198) in the L arm at 1715 and the Fucelvax Influenza vaccine (lot #308496) in the R arm at 1716 by vaccinator. At 1735 the client notifiedEMT that she "feels hot" and EMT immediately notified Lead RN . RN assessed the client while EMT provided the client water and took client''s vitals. RN assessed a rash across the client''s chest. Client was A&O x4 and denied SOB, dizziness, nausea, and pain. No swelling observed. Client stated that her lower arms felt "itchy". Client stated she had NKDA, no chronic conditions, and did not have a reaction to her first 2 doses of Pfizer or previous Influenza Vaccines. Client stated the last time she received the Influenza vaccine was 2 years ago. At 1735 client''s vitals were 180/108, HR 99, SPO2 99%, and RR 18. RN recommended that the client take IM Benadryl to help relieve symptoms. Client agreed to taking Benadryl and EMT assisted client to zero gravity chair. At 1742 RN drew up 50mg of Benadryl and administered to the client in the L arm, 1 inch away from the Flucelvax injection. During administration of IM Benadryl, some of the vaccine was wasted and leaked out of the syringe. RN notified Vaccine Operations Leadswho advised that re-administration of Benadryl is not indicated. At 1752 clients vitals were BP 140/106, HR 85, SPO2 98%, and RR 16. Client reported that the last time she ate was around 12pm. EMT provided client another water and saltine crackers. RN educated the client on the effects of Benadryl and the client verbalized understanding. At 1757 the client stated that the "heat" sensation was almost gone and stated "the pumping of my heart is much better". RN observed very mild redness on the chest, and no rash on the chest or arms was observed. Client stated that her itchiness on the arms was "almost better" and stated that she felt very mild itchiness on her back. RN assessed client''s back and did not observe any redness or rash. At 1800 client''s vitals were BP 136/98, HR 78, SPO2 98% and RR 16. The client continued to drink water and ate crackers. After futher assessment, the client remembered that she has an allergy to sulfa drugs and ampicillin. Client is not taking any medication. At 1609 client stated she "doesn''t feel hot anymore". RN advised the client that she should not drive home and her mom who was with her said they will call her uncle to pick them up. RN advised the client remain in observation for a full 30 minutes after administration of Benadryl. At 1815 client''s vitals were 148/106, HR 86 SPO2 100% and RR 16. Client stated the itchiness on her arms and upper back was returning but it was "bearable". RN recommended calling EMS due to return of symptoms but client denied. At 1620 client stated the heat was returning and she felt like there was a "heaviness" in her throat. RN notified client that due to symptoms, protocol requires activation of EMS. RN activated EMS at 1620. At 1621 the client was A&O x4, client''s SPO2 was 100%, and no swelling of the face, neck, or throat was observed. RN assessed erythema on the chest and upper back. At 1625 EMS assumed care of client.


VAERS ID: 2025894 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: California  
Vaccinated: 2022-01-10
Onset: 2022-01-10
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye swelling, SARS-CoV-2 test negative, Swelling face, Swelling of eyelid, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Latex, Eggs, peanuts, tree nuts, avocadoes, peaches, apples, carrots, bananas, tomatoes, kiwi
Diagnostic Lab Data: Took a COVID antigen rapid test before entering urgent care facility. result was negative. Had two doses of Moderna prior with no side effects. This was the first flu shot ever received.
CDC Split Type:

Write-up: Swelling of the left eye and development of hives on the arms hands and legs about 2 hours after injections, around 9pm. Next morning left eye was swollen shut and left side of face was swollen. Hives deloped on stomach hips and butt. Took benadryl around 9am. Didn''t help. Hives continued to spread down face, into nose and mouth. Hives continued to spread on extremities. Went to urgent care around 2pm. Was given a steroid injection and prescribed oral steroids. Hive spread has now stopped.


VAERS ID: 2204294 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Male  
Location: California  
Vaccinated: 2022-03-08
Onset: 2022-03-08
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL8095 / 1 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308496 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Dizziness
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre 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: Unknown
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client and his mother reported the client developed dizziness, weakness, "like he had no strength," about 5 hours after the vaccine that lasted 15-20 minutes. Client and his mother denied any other symptoms. The client''s mother gave him water and Paracetamol. The client had only eaten breakfast on the day he received the vaccine, and he received the vaccine at 5PM.


VAERS ID: 2696857 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: California  
Vaccinated: 2023-10-02
Onset: 2023-10-03
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HD9876 / UNK LA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 4794514-02126 / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pain in extremity
SMQs:, 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: Lorazepam, lithium, aripiprazole, Buspirone, levothyroxine
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Was seen by Dr on 10/09/2023
CDC Split Type:

Write-up: Symptoms: severe pain in left arm for over two weeks after the shot was administered


VAERS ID: 2698224 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Female  
Location: California  
Vaccinated: 2023-10-18
Onset: 2023-10-18
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 204F23A / N/A LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944497 / N/A RA / IM

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

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

Write-up: Five minutes after being administered the vaccine, the patient stated not knowing where she was and also stated to feel dizzy, but did not faint. The parent became concerned, and a bystander called emergency services. EMS arrived, after which the patient stated to start feeling better. Parent refused EMS services. Both parent and patient left without further incident. No history of adverse reactions to vaccines listed on the intake form. Unclear if this was a true adverse reaction to the vaccine or whether this was due to other circumstances.


VAERS ID: 2021990 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: California  
Vaccinated: 2022-01-07
Onset: 2022-01-07
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3209 / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 3C8484 / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, Pallor, Seizure, Tongue biting
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), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Patient lost consciousness as observed by accompanying guardian. Per guardian, patient also had a short seizure and skin color turned pale. Episode lasted less than 1 minute. Pharmacist was alerted but patient already regained consciousness and did not need epinephrine or interventions. Recommended patient lower head in seated position to increase blood flow. Patient also bit tongue during episode. Recommended patient stay for another 15 minutes for observation. Followed up with guardian on Monday 1/10/22 and no further incidents reported.


VAERS ID: 2685606 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: California  
Vaccinated: 2023-09-22
Onset: 2023-09-23
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3030342 / N/A LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370653 / N/A - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lymphadenopathy, Mobility decreased, Tenderness
SMQs:, Parkinson-like events (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Wellbutrin 450mg Prozac 20mg Vitamin D 2000
Current Illness: N/a
Preexisting Conditions: Obesity HSV-2
Allergies: N/a
Diagnostic Lab Data: N/a
CDC Split Type:

Write-up: Felt one supraclavicular lymphadenopathy +-peas sized node same left side as vaccine. Tender, moved around, presents less mobile when neck stretched away/ear to shoulder right side; somewhat tender/sensitive. Will monitor size over next week -6weeks


VAERS ID: 2698227 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: California  
Vaccinated: 2023-10-16
Onset: 2023-10-16
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HD9835 / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 373596 / 1 LA / IM

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: DIZZINESS
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT PASSED OUT AFTER RECEIVING A DOSE OF 23/24 COMIRNATY PFIZER COVID VACCINE AND A DOSE OF SEASONAL FLU VACCINE. AMBULANCE WAS CALLED. PATIENT REGAINED CONSIOUSNESS BY THE TIME ANMBULANCE ARRIVED. REFUSED FUTHER EVALUATION/RIDE IN AMBULANCE OFFERED BY THE EMERGENCY CREW AS A FOLLOW UP. PATIENT WAITED FOR ABOUT 15 MINUTES IN PHARMACY WAITING AREA AND GOT A FRIEND TO PICK HER UP


VAERS ID: 2615445 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: California  
Vaccinated: 2022-09-22
Onset: 2023-03-27
   Days after vaccination: 186
Submitted: 0000-00-00
Entered: 2023-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH GH9694 / 4 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 942386 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Oropharyngeal pain, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test negative, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Previous COVID vaccines - mild achiness and fever lasting one day
Other Medications: Lipitor; Uroxatral; Multivitamin
Current Illness: N/A
Preexisting Conditions: High Cholesterol
Allergies: Sulfa; Latex
Diagnostic Lab Data: 27MAR2023 - COVID-19 At Home Test - Negative; 28MAR2023 - COVID-19 At Home Test - Negative; 29MAR2023 - COVID-19 At Home Test - Negative
CDC Split Type: vsafe

Write-up: It started with a cough, sore throat, a little fever, congestion, and really bad wheezing.


VAERS ID: 2613998 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: California  
Vaccinated: 2022-10-14
Onset: 2023-02-27
   Days after vaccination: 136
Submitted: 0000-00-00
Entered: 2023-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH GJ5342 / 4 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 RA / IM
VARZOS: ZOSTER (SHINGRIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Brain fog, COVID-19, Chills, Fatigue, Nasal discomfort, Oropharyngeal pain, Pain, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalopathy/delirium (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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin; Truvada; Centrum Silver Men; Zyrtec; Salmon Oil; Baby Aspirin
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Cherries; Plums
Diagnostic Lab Data: 02/28/2023, COVID-19 Test, Positive
CDC Split Type: vsafe

Write-up: I had a sore throat, congestion, irritation in sinuses, high fever of 103.4, temperature dropped to 95, chills, body aches, brain fog, and fatigue. I tested positive for COVID-19. I spoke to my doctor, and they prescribed me Paxlovid. The brain fog lasted for 2 weeks, and the fatigue lasted for a week and a half.


VAERS ID: 2028517 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: California  
Vaccinated: 2022-01-11
Onset: 2022-01-11
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3209 / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308497 / 1 RA / IM

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

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

Write-up: Vaccinator inserted the needle into the client''s left deltoid muscle. Upon activation of the plunger the vaccinator noted fluid dripping on the client''s arm. Once the vaccinator noted the liquid on the client''s arm she stopped administering the vaccine and removed the needle from the client''s arm. Lead RN noted the plunger had been depressed approximately 0.03 milliliters. Per CDC guidance, the client received a repeat dose of 0.3 mL of Pfizer COVID vaccine (Lot#FL3209 exp: 06/30/2022) in the left deltoid muscle at 3:07PM. The client also received the Flucelvax Quadrivalent vaccine (Lot#308497 exp: 06/30/2022) in the right deltoid muscle at 3:07PM. The client did not report any symptoms during the 15 minute observation period. Lead RN educated client on possible adverse reactions and when to seek medical care. The client left the vaccination site ambulating unassisted with a steady gait.


VAERS ID: 2155976 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: California  
Vaccinated: 2022-02-17
Onset: 2022-02-17
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045L21A / UNK - / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308431 / UNK - / SYR

Administered by: Unknown       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: "The vaccine this patient received was determined to have had a temperature excursion below the recommended storage temperature prior to administration. There was no guidance to repeat the dose from the vaccine manufacturer."


VAERS ID: 2704137 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: California  
Vaccinated: 2023-10-27
Onset: 2023-10-27
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3031897 / N/A LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370673 / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Immediate post-injection reaction
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (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 had appointment to receive 3 vaccines (COVID, flu, and Tdap). Patient received the flu and COVID vaccines, and reported to have started feeling dizzy right away. Elevated patient''s legs in the vaccination room, then patient says started feeling better. I escorted the patient out the vaccination room to the waiting area and had the patient rest with legs elevated for 30 minutes. After that the patient said felt much better and both of us agreed to reschedule the Tdap vaccine for another day. Patient states that this is the first time this has ever happened with vaccines, and only occurred seldom with blood draws. Recommended that patient follow up with primary care.


VAERS ID: 2685652 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: California  
Vaccinated: 2023-09-24
Onset: 2023-09-24
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3030371 / 1 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944487 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Immediate post-injection reaction, Seizure
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Generalised convulsive seizures following immunisation (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: on period. severe menstraul cramps per patient
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Gave patient Moderna Spikevax 2023-2024 on left arm then gave Flucelvax on right arm. Immediately after giving flu shot to patient. Patient fell forward, hitting the curtain on her way down to the floor. She had a seizure for about 5-10 seconds. I ran back to call 911. While dialing, she got up and asked what had happened. I told her what had happened. She told me not to call 911 and that she was okay. She stated that she had severe menstral cramps and she gets lightheaded easily whenever she is on her period. She stated she has never had a seizure before. Patient was given water and ibuprofen per her request. Pharmacy managers, checked in on her as well. After sitting for about 30-40 minutes, she let us know she was feeling better and asked to get escorted to her car. Staff escorted her out to her car.


VAERS ID: 1989524 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Female  
Location: California  
Vaccinated: 2021-12-28
Onset: 2021-12-29
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308496 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Incorrect dose administered, Syringe issue
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: presented to health center to receive COVID19 vaccine and flu vaccine. Client received flu vaccine after receiving COVID Pfizer PEDS vaccine, RN injected flu vaccine and as she was injecting some of the fluid leaked outside of syringe. Client and Mother were informed of incident. Incident was elevated to Clinical Lead. Client''s Mother was notified of CDC guidelines. Flu vaccine will have to be administered again. Client''s mother verbalized understanding and stated she would come back to have child revaccinated.


VAERS ID: 2708535 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: California  
Vaccinated: 0000-00-00
Onset: 0000-00-00
Submitted: 0000-00-00
Entered: 2023-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 4 - / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Injection site mass, Injection site pain, Myalgia, Nasopharyngitis, Thirst
SMQs:, Rhabdomyolysis/myopathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (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: Muscles ache at multiple areas of body, similar to having a cold. The injection area has a big lump under the skin and it?s hurt when touched. Also I feel fatigue and tired and it?s the fourth day after the vaccine. Also I feel thirsty and drank a lot of water.


VAERS ID: 2597796 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: California  
Vaccinated: 2022-09-13
Onset: 2023-03-10
   Days after vaccination: 178
Submitted: 0000-00-00
Entered: 2023-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AS7145B / 5 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Fatigue, Oropharyngeal pain, Paranasal sinus discomfort, Pyrexia, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: COVID-19 Test, 03/10/2023
CDC Split Type: vsafe

Write-up: I started feeling very exhausted, sore throat, sinus pressure, and fever for the first day. I tested positive for COVID-19 at home. My doctor prescribed me Paxlovid. I started to feel better in a couple of days.


VAERS ID: 1979809 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: California  
Vaccinated: 2021-12-10
Onset: 2021-12-24
   Days after vaccination: 14
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045J21A / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308486 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
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 fainted after getting second vaccination (Moderna booster dose 0.25ml).


VAERS ID: 2686655 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: California  
Vaccinated: 2023-09-21
Onset: 2023-09-22
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3030371 / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944461 / 7+ LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Escitalopram 20mg, Atorvastatin 20mg, Losartan/HCT 100-25 & Metformin 500mg
Current Illness: N/A
Preexisting Conditions: Type 2 Diabetes, High Blood Pressure, High Cholesterol, Osteoarthritis, & Heart Disease
Allergies: N/A
Diagnostic Lab Data: The Moderna shot was administered with the seasonal flu vaccine FLUCEL VAX QUAD 2023-2024 SYR. Volume - 0.5 mL, Route - IM in Left Deltoid. Only minor soreness was felt immediately after both vaccines were administered.
CDC Split Type:

Write-up: The onset of chills, nausea, and dizziness. All of which lasted 4 to 6 hours prior to sleep.


VAERS ID: 1874825 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: California  
Vaccinated: 2021-10-02
Onset: 2021-10-02
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 RA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308444 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Blood test, Dizziness, Electric shock sensation, Electrocardiogram, Feeling abnormal, Impaired driving ability, Nausea, Panic attack, Tremor
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Janumet, Claritin, Omega Supplement
Current Illness: N/A
Preexisting Conditions: Diabetes, asthma
Allergies: Penicillin, iodine/ shellfish, latex
Diagnostic Lab Data: EKG, blood tests done at urgent care on that 3rd day. I believe it was Tuesday, October 5.
CDC Split Type:

Write-up: I was fine for the first 15-20 minutes. About 20-25 minutes later, I was driving home with my child and came to a stoplight. Some kind of rush started from my feet and rose up to my head. I described it as lightheadedness but it was actually a different feeling; almost like a jolt. My hands started trembling. I had to outline over and call my family to pick us up. I was nauseated the rest of the day. The next 2 days, I was okay. On the 3rd day, the jolts started happening again (once per day at any given time) and I started having panic attacks and anxiety. I even called my physician and went to urgent care on that 3rd day. I haven''t driven since because I haven''t felt safe. 6 weeks, multiple doctor and therapist visits later, I''m finally starting to feel "normal" again.


VAERS ID: 2723266 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: California  
Vaccinated: 2023-12-09
Onset: 2023-12-10
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-12-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HG4671 / 4 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944461 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ear inflammation, Headache, Tinnitus
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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: 24 hours after the vaccines I started experiencing ringing and inflammation in both ear, particularly worst on my right ear. My inner ear feels inflamed and pounding when I''m walking and I''m constantly hearing a ring as if I had been to a super loud concert, which I haven''t. It''s been more that 3 days now and the ringing is not stopping. I reached out to my PC and waiting to hear back on whether I need to be seen or not.


VAERS ID: 2725892 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: California  
Vaccinated: 2023-12-13
Onset: 2023-12-13
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 203F23A / N/A LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370670 / N/A RA / IM

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

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

Write-up: On 12/13/2023, during the flu and Covid 19 pre-vaccination check patient was asked if she received flu or Covid vaccination in the last 12 months. Patient stated:? No, I had no vaccine in the last 12 months?. Flu vaccine was administered, and no adverse or allergic reactions were noted. After entering the vaccine administration into our electronic health record, we noticed that patient received flu vaccine in September 2023 from different organization. I contacted the patient and asked her to confirm previous flu vaccine. Patient stated: ?Yes, I received the flu vaccine in September 2023?. When asked, why she did not report the vaccine during pre-vaccination check, patient stated: ?I forgot, we have to many vaccines to remember?. When asked if she experienced any adverse or allergic reaction after vaccine administration, patient stated:? No, I feel good?.


VAERS ID: 2730980 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: California  
Vaccinated: 2024-01-02
Onset: 2024-01-03
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2024-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3031416 / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944467 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: tizanidine 2mg, montelukast 10mg, amlodipine 5mg
Current Illness: urine infection
Preexisting Conditions: hypertension
Allergies: penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Itchiness all over body


VAERS ID: 1808516 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: California  
Vaccinated: 2021-10-21
Onset: 2021-10-21
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 320308D / 3 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308491 / N/A LA / IM

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

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

Write-up: Vaccination Error. Patient was scheduled for covid 3rd booster dose. However, at registration window, BOOSTER dose was mistaken to FLU SHOT and somehow patient''s insurance went through. Patient was administered FLU SHOT. However, after the shot, patient reported she already got flu shot 2 weeks ago and she actually wanted booster dose. After monitoring patient for 30 minutes, since patient still wanted booster dose, 3rd covid pfizer vaccine was administered. Additional monitoring time of 15 minutes was allowed. Patient did not have any reaction. Patient tried to be reached today (10/22) but unable to reach.


VAERS ID: 2733352 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: California  
Vaccinated: 2024-01-11
Onset: 2024-01-11
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2024-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HM7006 / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 373660 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion, Immediate post-injection reaction, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (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: NONE
Current Illness: NONE
Preexisting Conditions: UNKNOWN; PT DOESN''T RECEIVED MEDICATIONS FROM OUR PHARMACY
Allergies: MACROLIDES, KETOLIDES, PENICILLINS
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: IMMEDIATELY AFTER RECEVING THE COMIRNATY 23-24 VACCINE ON THE LEFT ARM, IT SWELLED UP MORE THAN USUAL. PATIENT WAS FEELING FINE. PATIENT WAS TO PUT UNDER OBSERVATION FOR 15 MINS AND RELEASED. THE SWELLING WENT DOWN LITTLE BIT WHEN PATIENT WAS RELEASED. PATIENT WAS CONTACTED ON 1/16/2024. PATIENT SAID THE SWELLING IS COMPLETELY GONE, BUT THERE IS A BRUISE. PATIENT


VAERS ID: 1813621 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: California  
Vaccinated: 2021-10-18
Onset: 2021-10-19
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2021-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308444 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Fatigue, Mobility decreased, Myalgia, Pain, Pyrexia, Sleep disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Wooziness and disorientation, fatigue following Pfizer COVID-19 shot #1 on 3/15/21
Other Medications: 75 mg Bupropion daily 5,000 IU vitamin D3 daily 180 mcg vitamin K2 daily
Current Illness: none
Preexisting Conditions: fibromyalgia
Allergies: pine
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Woke up in the middle of the night following the shots with chills and 101 fever, severe joint aches and muscle/body aches. Tylenol brought fever down to 100 range but chills persisted for a total of 2 nights and fever stayed above 100 until 72 hours after shots, when it came down to 99 range. Finally in normal range 90 hours after shots received. Muscle/body aches persisted for 72 hours and exhaustion persisted over a week. Could not sit up in bed or get out of bed all day Tuesday and Wednesday after receiving shots Monday.


VAERS ID: 2740200 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: California  
Vaccinated: 2023-12-16
Onset: 2023-12-16
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2024-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HH3221 / UNK RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944480 / UNK 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: The Comirnaty Pfizer vaccine was discovered to not have been stored according to the labeling and was kept in the freezer longer than what the manufacturer requires. We''ve reached to the manufacturer and CDC and unfortunately they don''t have the data to support storage beyond the recommended time allowed. The vaccine was unfortunately administered before the discovery. Patient was contacted and offered to revaccinate. Patient did not experience any adverse reaction from this vaccination.


VAERS ID: 2740203 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: California  
Vaccinated: 2023-12-29
Onset: 2023-12-29
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2024-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HH3221 / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944480 / UNK RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: The Comirnaty Pfizer vaccine was discovered to not have been stored according to the labeling and was kept in the freezer longer than what the manufacturer requires. We''ve reached to the manufacturer and CDC and unfortunately they don''t have the data to support storage beyond the recommended time allowed. The vaccine was unfortunately administered before the discovery. Patient was contacted and offered to revaccinate. Patient did not experience any adverse reaction from this vaccination.


VAERS ID: 2740204 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: California  
Vaccinated: 2023-12-29
Onset: 2023-12-29
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2024-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HH3221 / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944480 / UNK RA / IM

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

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

Write-up: The Comirnaty Pfizer vaccine was discovered to not have been stored according to the labeling and was kept in the freezer longer than what the manufacturer requires. We''ve reached to the manufacturer and CDC and unfortunately they don''t have the data to support storage beyond the recommended time allowed. The vaccine was unfortunately administered before the discovery. Patient was contacted and offered to revaccinate. Patient did not experience any adverse reaction from this vaccination.


VAERS ID: 1870916 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: California  
Vaccinated: 2021-10-25
Onset: 2021-10-26
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2021-11-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Chest pain, Computerised tomogram, Dyspnoea, Electrocardiogram, Heart rate increased, Myocarditis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (broad), Noninfectious myocarditis/pericarditis (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Claritin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: CT scan 10/27/2021. EKG (qty 4) 10/27/2021. Blood panel. Cardiogram.
CDC Split Type:

Write-up: Beginning 24 hours after the vaccine, I had shortness of breath, chest pain and increased heart rate. I did not have these reactions with prior doses. I went to urgent care, and they transferred me to the emergency room. They discharged me 10 hours later, and told me it was mild myocarditis. I had symptoms for 6 days. I still have slight shortness of breath and rapid heart rate when exerting myself.


VAERS ID: 2689021 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Colorado  
Vaccinated: 2023-09-30
Onset: 2023-09-30
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AU3833D / 1 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 374408 / 1 LA / IM

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

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

Write-up: After administration of both vaccines patient felt dizzy and lightheaded. Patient looked a little pale and had to remain in her seat until she felt better. She remained consciousness the entire time.


VAERS ID: 1862540 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Colorado  
Vaccinated: 2021-11-05
Onset: 2021-11-06
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 320308D / 3 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Arthralgia, Dizziness, Dysstasia, Fatigue, Gait disturbance, Headache, Limb discomfort, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Dulara (asthma), ibuprofen
Current Illness:
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: None. Called online nurse on Day 7
CDC Split Type:

Write-up: Day 2: severe headache; bad pain in joints and muscles; trouble walking and standing, legs and arms felt very heavy; Day 3: fatigue Day 6: severe dizziness from 7am to 1pm; sick at stomach but no vomiting; could not walk--had to crawl, fatigue rest of day


VAERS ID: 2689389 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Colorado  
Vaccinated: 2023-09-19
Onset: 2023-09-20
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HH7595 / 1 AR / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. I DON''T KNOW / 1 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test abnormal, Cardiac imaging procedure normal, Carditis, Chest pain, Echocardiogram normal, Myocarditis, Troponin increased
SMQs:, Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), Noninfectious myocarditis/pericarditis (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? Yes, 3 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Omnitrope, Anastrozole
Current Illness: n/a
Preexisting Conditions: Growth hormone deficiency
Allergies: n/a
Diagnostic Lab Data: Elevated Triponin on all blood draws from 9/21-9/23; Cardiac echo on 9/22; Cardiac MRI on 9/23. Heart inflammation not visible on echo or MRI, but indicated from sypmtoms and blood.
CDC Split Type:

Write-up: On and off chest pain beginning about 18 hours after vaccine administration. Took him to ER after 24 hours of symptoms. Triponin numbers were elevated upon arrival (157) and continued rising (170). He was admitted to hospital for 3 days while undergoing continued blood tests to monitor Triponin, heart echo, and cardiac MRI. Was symptomatic with chest pain on and off throughout hospital stay. Suspected myocarditis from vaccine.


VAERS ID: 2689676 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Colorado  
Vaccinated: 2023-10-02
Onset: 2023-10-02
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 205E23A / UNK RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370657 / UNK RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 felt lightheaded and passed out after he stood up right after getting the shots. Parents helped laying him down on the floor till paramedics arrived. He was alert and oriented, breaing normally by the time paramedics arrived.


VAERS ID: 2479530 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Colorado  
Vaccinated: 2022-10-14
Onset: 2022-10-14
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FT1551 / 3 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 348359 / UNK LA / IM
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. 1780878 / 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENQUADFI) / SANOFI PASTEUR U7249AB / 1 RA / IM

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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Recent illness with neg rapid strep.
Preexisting Conditions: BMI 95-99%, tonsillar hypertrophy, snoring
Allergies: None
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: NO adverse events. Administration of monovalent COVID-19 #3, not recently approved bivalent COVID-19 vaccine.


VAERS ID: 2530666 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Colorado  
Vaccinated: 2022-12-13
Onset: 2022-12-13
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH GJ3275 / 4 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 942437 / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Injection site pain, Loss of consciousness, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (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? 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 felt dizzy after getting Flucelvax shot since it "hurt". Waited a minute and then gave COVID booster when patient was ready. Patient began to feel more lightheaded and turned pale. Patient fainted and had difficulty coming to. Pharmacy Intern got the pharmacist for help and called 911. Patient was moved to the floor. Paramedics arrived and took over the situation. Patient was transported out on a stretcher but was alert and oriented.


VAERS ID: 2644714 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Colorado  
Vaccinated: 2022-10-12
Onset: 2022-10-12
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-06-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 055F22B / 4 LA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 348371 / UNK RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acupuncture, Circumstance or information capable of leading to medication error, Conversion disorder, Dyskinesia, Magnetic resonance imaging, Tremor, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Dyskinesia (narrow), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Hypersensitivity (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, Apri, Sertraline
Current Illness: N/A
Preexisting Conditions: Hypothyroidism, Hashimoto''s
Allergies: N/A
Diagnostic Lab Data: MRI - October No other tests were taken
CDC Split Type:

Write-up: Uncontrollable movements began with foot moving and full body shakes 3 hours after the shot was given. Shakes progressively moved throuhgout body to every part, including face and throat movement. Went to ER a total of 4 times, no answers for the condition were given any visit. Primary care doctor prescibed muscle relaxers and benzos while I waited for a Neurologoist. Also tried acupuncture, to help during this time. Had a huge welt on my arm for a month. Was diagnosed with Functional Neurological Disorder December 9, 2022. Still going to acupuncture, functional medicine doctors to help symptoms. Still dealing with ongoing symptoms as of June 2023. (pharmacy report states both the flu and COVID shot were adminstered in left arm, but they were not. One was in left and one was in right. COVID was left and flu was right.)


VAERS ID: 2712502 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Colorado  
Vaccinated: 2023-11-08
Onset: 2023-11-09
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Headache, Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Tendinopathies and ligament disorders (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: B complex, fluticasone propionate nasal spray, vitamin D, Zyrtec Mirena, azelaic acid gel
Current Illness: none
Preexisting Conditions: allergic rhinitis, prediabetes
Allergies: Penicillin
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pt had a syncopal event 12 hours after her flu and COVID vaccines were administered at her local pharmacy. She has had flu and COVID vaccines in the past (previous Pfizer for COVID) but not on the same day in the past. She was able to get up and get back in bed. Endorses some HA, neck ache, chills, and nausea, which have since resolved.


VAERS ID: 2715462 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Colorado  
Vaccinated: 2023-11-18
Onset: 2023-11-18
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HG9498 / 4 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 9444495 / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Immediate post-injection reaction, Injection site haemorrhage, Injection site pain, Nerve injury, Pain, Product administered at inappropriate site
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Drug abuse and dependence (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), 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: NONE
Diagnostic Lab Data: unsure
CDC Split Type:

Write-up: patient was very worked up about getting vaccines and intern spent several minutes waiting for patient to be ready for injection. She did not allow intern to give one vaccine per arm as planned and instead asked for both in the same arm. The second shot was giving in the lower part of the arm below the deltoid muscle. The patient reported immediate pain radiating into her armpit, and bleeding from second injection site. Two days later patient was still experiencing stabbing pain in their upper arm and armpit for a 7/10 pain. Patient went to pediatrician for pain treatment and they believe it injured the axial nerve.


VAERS ID: 2715751 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Colorado  
Vaccinated: 2023-11-18
Onset: 2023-11-18
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / UNK RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Injected limb mobility decreased, Nausea, Pain in extremity
SMQs:, Acute pancreatitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: Vyvance, trazodone, lexapro,, fish oil, turmeric , b-12, vitamin D
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pain in the left arm so bad that I don?t have strength in the limb, cannot raise the arm and move. Nausea related to the pain.


VAERS ID: 1808025 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Colorado  
Vaccinated: 2021-10-13
Onset: 2021-10-21
   Days after vaccination: 8
Submitted: 0000-00-00
Entered: 2021-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 1 LA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308435 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pruritus, Injection site swelling, Lymph node pain, Lymphadenopathy
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (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: Multi-vitamin, Metamucil, Glutamine, Inositol
Current Illness: Upper respiratory virus
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: No
CDC Split Type:

Write-up: 7 days after the Moderna shot, I developed a large knot at the injection site. It is slightly itchy and red. The next day (10/22), I also have a swollen lymph node, about the size of a pea on the left side of my neck. The underarm area is also tender.


VAERS ID: 1873742 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Colorado  
Vaccinated: 2021-11-12
Onset: 2021-11-13
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Back pain, Chest pain, Headache, Hypoaesthesia, Impaired work ability, Malaise, Pain in extremity, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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: clonidine, gabapentin, lithium quetiapine
Current Illness:
Preexisting Conditions:
Allergies: nkda
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reports started feeling "sick" the next morning. Reports could not go to work Saturday, Sunday, Monday. Reports "chest hurts, back hurts, left arm is numb, right arm hurts, stomach upset, headache, 101.3 fever". Reports has been taking "Back and Body" which contains aspirin and caffeine. Denies shortness of breath, rash


VAERS ID: 2740933 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Connecticut  
Vaccinated: 2023-11-10
Onset: 0000-00-00
Submitted: 0000-00-00
Entered: 2024-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AU3917B / UNK RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944471 / UNK 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: Cashews and egg whites} severe intolerance peanuts and pecans }
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Administered vaccine post 30 days Moderna COVID-19 Lot AU3917B Per Moderna Medical Support (11/22/2023) the vaccine maintained the activity necessary to protect against the virus.


VAERS ID: 2740938 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Connecticut  
Vaccinated: 2023-11-10
Onset: 0000-00-00
Submitted: 0000-00-00
Entered: 2024-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AU3917B / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944471 / 1 RA / IM

Administered by: Private       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: Synthroid Omeprazole Prozac
Current Illness: None
Preexisting Conditions: Hypothyroid
Allergies: Zithromax
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Administered vaccine post 30 days Moderna Covid-19 Lot AU3917B Per Moderna Medical Support (11/22/2023) the vaccine maintained the activity necessary to protect against the virus.


VAERS ID: 2711727 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Connecticut  
Vaccinated: 2023-10-26
Onset: 2023-11-04
   Days after vaccination: 9
Submitted: 0000-00-00
Entered: 2023-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HF9275 / 1 LA / OT
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 RA / -

Administered by: Work       Purchased by: ?
Symptoms: COVID-19, Drug ineffective
SMQs:, Lack of efficacy/effect (narrow), 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:
Current Illness: Community-related COVID-19 exposure
Preexisting Conditions: Medical History/Concurrent Conditions: Atopic dermatitis
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202300356841

Write-up: suspected signs and symptoms of COVID-19 as follows: mild shortness of breath with moderate walking, dizziness, mild headache, mild GI upset; suspected signs and symptoms of COVID-19 as follows: mild shortness of breath with moderate walking, dizziness, mild headache, mild GI upset; This is a spontaneous report received from a contactable reporter(s) (Physician) from product quality group. The reporter is the patient. A 54-year-old female patient (not pregnant) received bnt162b2 omi xbb.1.5 (COMIRNATY (2023-2024 FORMULA)), on 26Oct2023 at 12:00 as dose 1, single (Lot number: HF9275) at the age of 54 years intramuscular, in left arm for covid-19 immunisation; influenza vaccine inact sag 4v (FLUCELVAX QUAD), on 26Oct2023 as dose 1, single (Batch/Lot number: unknown), in right arm for immunisation. The patient''s relevant medical history included: "Dermatitis atopic" (unspecified if ongoing); "Exposed to Covid-19 via domestic partner" (ongoing). There were no concomitant medications. Vaccination history included: pfizer covid 19 vaccine (DOSE 4 (BOOSTER), SINGLE, bivalent), administration date: 06Dec2022, when the patient was 53-year-old, for COVID-19 immunization; bnt162b2 (DOSE 3 (BOOSTER), SINGLE), administration date: 05Apr2022, when the patient was 53-year-old, for COVID-19 immunization; bnt162b2 (DOSE 1, SINGLE), administration date: 27Mar2022 (as reported), for COVID-19 immunization; bnt162b2 (DOSE 2, SINGLE), administration date: 17Apr2021, when the patient was 52-year-old, for COVID-19 immunization. The following information was reported: DRUG INEFFECTIVE (medically significant), COVID-19 (medically significant) all with onset 04Nov2023, outcome "not recovered" and all described as "suspected signs and symptoms of COVID-19 as follows: mild shortness of breath with moderate walking, dizziness, mild headache, mild GI upset". Therapeutic measures were not taken as a result of drug ineffective, covid-19. Clinical course: Exposed to Covid-19 via domestic partner (no recent Covid vaccinations, only 2 primary series received 2021), who tested Covid positive in nasal swab test on 04Nov2023. My symptoms started the same day. Highly suspected signs and symptoms of COVID-19 as follows: mild shortness of breath with moderate walking, dizziness, mild headache, mild GI upset, eye light sensitivity, mild dry cough, mild rhinorrhea, joint/muscle aches, fatigue, somnolence, hypersomnia (slept 18 hours during a 24 hr period), mild temperature and occasional shivers. Still ongoing symptoms. Have had COVID-19 three times before over past 3 years. Did not do COVID test at this time.; Sender''s Comments: Based on available information, a lack of efficacy with the suspect vaccine bnt162b2 omi xbb.1.5 in this patient cannot be completely excluded.


VAERS ID: 2689440 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: D.C.  
Vaccinated: 2023-09-30
Onset: 2023-10-02
   Days after vaccination: 2
Submitted: 0000-00-00
Entered: 2023-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 8057965 / 4 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370652 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Injection site erythema, Injection site pain, Myalgia, Sensitive skin
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (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: Tretinoin Vitamin D Vitamin B 12 Iron Vitamin C
Current Illness: None
Preexisting Conditions: Scoliosis
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Injection site pain, redness, burning (8am 10/2-ongoing) other symptoms: Muscular arm pain (11am 9/30-ongoing) Fatigue (5pm 9/30-10am 10/1) Full body skin sensitivity (8pm 9/30-10am 10/1) Headache (8pm 9/30-10am 10/1)


VAERS ID: 2246026 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: D.C.  
Vaccinated: 2021-10-12
Onset: 2022-01-31
   Days after vaccination: 111
Submitted: 0000-00-00
Entered: 2022-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 30135BA / 3 AR / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / UNK AR / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Appendicectomy, Appendicitis, COVID-19, Diarrhoea, Fatigue, Headache, Laboratory test normal, Magnetic resonance imaging abdominal abnormal, SARS-CoV-2 test positive, Sleep disorder
SMQs:, Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Birth control.
Current Illness: None.
Preexisting Conditions: None.
Allergies: Shellfish; I donated a Kidney so I cannot do NSAIDS.
Diagnostic Lab Data: 02/03/2022 Rapid COVID-19 test, pharmacy, positive. 02/17/2022 Emergency Room. COVID-19, neg. Labs normal. MRI, Appendicitis.
CDC Split Type: vsafe

Write-up: On Monday 01/31/2022 I had diarrhea. On Wednesday I woke up in the middle of the night with a severe headache and on Thursday I was tested. Fatigue and headache lasted 24 hours. Two weeks later I did have Appendicitis and my Appendix was removed.


VAERS ID: 1925089 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Delaware  
Vaccinated: 2021-12-06
Onset: 2021-12-06
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308485 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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), 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: n/a
Current Illness: n/a
Preexisting Conditions: na
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient passed out directly after receiving her second vaccine of the day, the flu vaccine. She regained consciousness within 1 minute and we applied cold pack to her neck and gave her cold water to drink. patient remained in the store under observation for 30 mins and felt fine when she left. No residual dizziness or light headedness.


VAERS ID: 2696440 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Florida  
Vaccinated: 2023-10-15
Onset: 2023-10-15
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HG2282 / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370661 / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injected limb mobility decreased, Injection site erythema, Injection site pain, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (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: unknown
Preexisting Conditions: unknown
Allergies: penicillin ,shellfish, iodinated diagnostic agents
Diagnostic Lab Data: Rec patient reach out to her provider for evaluation.
CDC Split Type:

Write-up: Patient had red and warm localized area on left arm and pain that was uncomfortable in area of vaccine and also went further into shoulder which made it difficult to move arm.


VAERS ID: 2696263 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Florida  
Vaccinated: 2023-10-09
Onset: 2023-10-10
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 8058581 / 1 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 372395 / 1 LA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. X018278 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angina pectoris, Decreased appetite, Dyspnoea exertional, Erectile dysfunction, Injection site haematoma, Libido decreased, Pain, Pyrexia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pulmonary hypertension (broad), Other ischaemic heart disease (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (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: but mild (about a day or half a day) in bed with fever and body ache (covid vaccine only).
Other Medications: Minoxidil oral medication 0.25mg/d
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Started with fever and body aches the day after the vaccine: fever lasted until 10/13 (not included), i.e., 4 days after the shot. Had to take pain medication. Loss of apetite for 3 days after taking the shot. Erectyle dysfunction (unknown to the day of the vaccine): no libido, no penile sensitivity or testicular sensitivity. This was about 90% loss on day 1 after vaccine, 80% on day 2, 50% of day 3, 50% on day 4, 40% on day 5, 20% on day 6 (today). Still not 100% recovered. Symptomes are great difficulty achieving an erection, no sensitivity around the genitalia. Hematoma the size of a tennis ball on the left arm (flu and pneumonia vaccines). Swollen enough for co workers to notice under garment. Painfull to the touch. Has subsided greatly after 6 days to non perceptible. No harsh reaction on the righ arm (Moderna). Heart was a bit painful and difficulty exercising that lasted about 5 days (short of breath). Better now after 6 days.


VAERS ID: 2400564 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Florida  
Vaccinated: 2022-08-03
Onset: 2022-08-03
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FP7150 / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 942371 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Immediate post-injection reaction, Loss of consciousness, Nausea, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: Amoxicillin
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Pfizer administered in left deltoid, then influenza administered in right deltoid. Patient immediately fainted after influenza vaccine. Once patient was seated, he immediately regained consciousness, breathing was regulated and he was able to speak. However, he was dizzy and nauseous. He vomited once. He was then given crackers, water and wet napkins for his face/neck. After being monitored for about ~30 minutes, he was physically able to walk out of the pharmacy. No medication administration, CPR or further healthcare was necessary. I called to check on patient at 18:30 (4 hours after he left the pharmacy). He was better, having no further events.


VAERS ID: 2686845 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Florida  
Vaccinated: 2023-09-26
Onset: 2023-09-26
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 202F23A / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Road traffic accident
SMQs:, Accidents and injuries (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-09-26
   Days after onset: 0
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: Diabetic
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt came in for Spikevax and Flucelvax. Vaccines administered. Shortly after leaving pharmacy patient was involved in car accident in which he died.


VAERS ID: 2397848 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Florida  
Vaccinated: 2022-01-13
Onset: 2022-02-02
   Days after vaccination: 20
Submitted: 0000-00-00
Entered: 2022-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK AR / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / UNK AR / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angioedema, Chronic spontaneous urticaria, Laboratory test
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Hypersensitivity (narrow), 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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Flu Vaccine taken same day as Pfizer booster on 1/13/2022
Current Illness: Tardive Dyskinesia , Psychosis
Preexisting Conditions: ASD, ADHD, Schizoaffective Disorder, PTSD, DMDD, Developmental Delays, Chung Jansen Syndrome, MTHFR
Allergies: Gluten, Dairy, Lithium, Saphris
Diagnostic Lab Data: Rheumatologist ordered labs to confirm autoimmune urticaria and angioedema 4/14/2022
CDC Split Type:

Write-up: Chronic Autoimmune Urticaria daily since the begin of February, full body Angioedema sporadically since May, facial mostly eyes and lips


VAERS ID: 2488581 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Florida  
Vaccinated: 2022-10-25
Onset: 2022-10-25
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050D22A / 5 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 348382 / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Confusional state, Discomfort, Movement disorder, Mydriasis, Pallor, Parosmia, Seizure like phenomena
SMQs:, Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: OFTEN
Other Medications: PENICILLIN VK 500 MG
Current Illness: TOOTH INFECTION
Preexisting Conditions: NONE
Allergies: NKA
Diagnostic Lab Data: UPON LEAVING HR = 60 BP = 125/75
CDC Split Type:

Write-up: DURING VACCINATION REPORTED NOT LIKING SMELL OF ALCOHOL. AFTER SHOT HE LEANED BACK AND LOOKED UNCONFORTABLE. THEN FATHER GOT A SHOT, AT THE END OF HIS FATHERS ADMINISTRATION (IMMEDIATELY AFTER) PATIENT WAS LOOKING PALE AND CLAMMY SOWE GAVE HIM A BOTTLE OF WATER AND SNACKS. THEN PATIENT BEGAN SUDDEN MOVEMENTS ALMOST AS IF HAVING SEIZURE. PATIENTS EYES WERE VERY DILATED. THIS IS ALL WITHIN 2 MINUTES OF VACCINE ADMINISTRATION. I AND THE PATIENTS FATHER BEGAN LIFTING PATIENT TO MOVE HIM TO THE FLOOR TO PREVENT INJURY. APPROXIMATLEY 10 SECONDS AFTER BEING LAID DOWN THE PATIENT WOKE UP AND ASKED "WHERE AM I?" "WHAT HAPPENED". HE BEGAN TO RECOVER ON THE FLOOR APPROXIMATLEY 5 MINUTES. THEN HE SAT IN THE CHAIR A COUPLE MINUTES. I REUQESTED HE CHECK HIS BLOOD PRESSURE - 125/75 HR = 60. PATIENT REPORTED THIS "ALWAYS HAPPENS " WHEN GETTING VACCINES AND INSISTED HE WAS OKAY.REFUSED TO STAY FOR THE PARAMEDICS


VAERS ID: 2504361 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Male  
Location: Florida  
Vaccinated: 2022-09-21
Onset: 2022-09-01
Submitted: 0000-00-00
Entered: 2022-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL8095 / 2 UN / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 942405 / 1 UN / IM

Administered by: Pharmacy       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: No adverse event occurred. Injection of Pfizer vaccine was administered on 09-21-2022, the BUD label on the vaccine packaging read 09-23-2022. However, the expiration date as per the MFR was 08-31-2022, MFR was contacted, so far no adverse events to report. Currently awaiting instructions to determine if whether or not an additional dose is required for protection against COVID-19.


VAERS ID: 2063053 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Florida  
Vaccinated: 2021-12-03
Onset: 2021-12-10
   Days after vaccination: 7
Submitted: 0000-00-00
Entered: 2022-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1620 / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308495 / N/A RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (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: N/a
Preexisting Conditions: unknown
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reports that about a week receiving the two vaccines in the same day she started experiencing a loss in upper arm strength and upper leg strength. It has not recovered and it has been six weeks.


VAERS ID: 2692420 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Florida  
Vaccinated: 2023-09-29
Onset: 2023-09-30
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 205F232A / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944481 / N/A RA / IM
RSV: RSV (ABRYSVO) / PFIZER/WYETH HF5017 / N/A RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Syncope, X-ray limb
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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Singulair Rx, acetaminophen otc
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: NKDA
Diagnostic Lab Data: ER visit : X-ray ankle
CDC Split Type:

Write-up: Fainted at a party at an outside BBQ on the day after the shots (for a baby shower in early evening)


VAERS ID: 2689104 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Florida  
Vaccinated: 2023-09-25
Onset: 2023-09-26
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 205E23A / UNK RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. U8067AA / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Decreased appetite, Fatigue, Headache
SMQs:

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

Write-up: PT CALLED PHARMACY AND STATED THAT SHE HAS BEEN FEELING FATIGUE, HEADACHE, DECREASED APPITITE. I RECOMMENDED TO TAKE ACETAMINOPHEN TO HELP WITH THE SYMPTOMS, AND IF SYMPTOMS GET WORSE TO GET MEDICAL ATTENTION


VAERS ID: 1795384 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Florida  
Vaccinated: 2021-10-17
Onset: 2021-10-17
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pallor, Pruritus, Swelling of eyelid, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Periorbital and eyelid disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Extremely itchy palms, red/swollen eyelids, hives all over chin, some on chest, hairline, inner elbow; paleness.


VAERS ID: 2268812 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Florida  
Vaccinated: 2021-12-20
Onset: 2021-12-30
   Days after vaccination: 10
Submitted: 0000-00-00
Entered: 2022-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Electromyogram, Hypoaesthesia, Immunoglobulin therapy, Movement disorder, Muscular weakness, Nerve conduction studies, Pain, Paraesthesia, Pneumonia, Pulmonary embolism, Thrombosis
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Thrombophlebitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sexual dysfunction (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 62 days
Extended hospital stay? No
Previous Vaccinations: GBS from seasonal influenza vaccine Nov 30,2005
Other Medications: see patient
Current Illness: no illnesses for the months of Oct 2021 to Dec 20,2021
Preexisting Conditions: GBS/CIDP, neuropathy, high blood pressure, high cholesterol, depression, anxieties and a list of others, see patient
Allergies: Cialis, Nuvigil
Diagnostic Lab Data: Lumbar puncture on 1/2/2022 unsuccessful EMG and Nerve conductivity test on lower extremities in Feb 2022, upper extremities in April 2022
CDC Split Type:

Write-up: Weakness, numbness/tingling in legs/feet hands and arms. Called rescue on 12/30/21 to transport to closest hospital transferred to Facility for treatment. Found pneumonia also at the time at started treatment for that. Tried to do a lumbar puncture but was unable because it hurt to much to try and lay still on my side for a period of time. Started a 3 day treatment of IVIG. Remained here for a total of 12 days. Transported to skilled nursing center where very little if any therapy was done. Got to a point where I could not move or lift arms or legs. Very weak and severe pain to move extremities. Spent 12 days here before I was transferred to Facility for additional treatment. Found now large amount of pulmonary embuli in right lung and embuli in left lung and a large amount of blood clots in upper and lower legs. Treated for 8 days for this and given a 5 day regiment of IVIG. on Feb 2 transferred to InPatient Hospital for rehab. Released on March 3, 2022 home for 6 weeks of home health care. Started in the middle of March 2022 for put patient rehab.


VAERS ID: 1940218 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Florida  
Vaccinated: 2021-11-05
Onset: 2021-11-07
   Days after vaccination: 2
Submitted: 0000-00-00
Entered: 2021-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / UNK - / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308434 / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysuria, Genital discomfort, Genital pain, Genital tract inflammation, Inflammation, Urethral pain, Urine analysis
SMQs:, Sexual dysfunction (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydroxychloroquine, Montelukast, Gabapentin, Cyclobenzaprine, Hydroxyzine, Buproprion XL, Premarin, Norco, Fish Oil/Omega, Xiidra, Flonase
Current Illness: N/A
Preexisting Conditions: Sjogrens, Interstitial Cystitis, Restless Leg, Seasonal Allergies, Anxiety
Allergies: Levaquin, Adhesive
Diagnostic Lab Data: Urinalysis and abdominal exam at Urgent Care Urinalysis and external pelvic exam at Urologist
CDC Split Type:

Write-up: Urethra, labia minora, clitoris pain made worse with urinating and wiping after urinating. Went to Urgent Care for assessment. No UTI or infection. Treated with 10 day course of antibiotics. Improvement after 6-7 days but back to original discomfort and pain after finishing antibiotics. Saw Urologist 12/03. No UTI or infection per urinalysis. Provider performed exam of effected areas and irritation/inflammation of area noted. Prescribed topical Clotrimazole w/ steroid to apply to area 2x a day x 10 days.


VAERS ID: 2684387 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Florida  
Vaccinated: 2023-09-20
Onset: 2023-09-21
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3030342 / UNK AR / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944448 / UNK AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Hypoaesthesia, Hypoaesthesia oral, Tremor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (broad), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: head hurts, shaking numbness all over including lips and mouth


VAERS ID: 1981170 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Florida  
Vaccinated: 2021-12-10
Onset: 2021-12-21
   Days after vaccination: 11
Submitted: 0000-00-00
Entered: 2021-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 060H21A / 3 LA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / UNK RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Mechanical urticaria, Rash, 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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None. Take Adderall XR 10mg occasionally, but had not taken it at time of vaccination.
Current Illness: Cold a few weeks before. Was not COVID-19. Got a PCR test to check.
Preexisting Conditions: None.
Allergies: Allergy to Nickel.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Spontaneous, moving rash. Random hives breakout on body. Mainly concentrated in hands, back, neck and chest. Dermatographia seems to be occurring.


VAERS ID: 2705872 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Florida  
Vaccinated: 2023-10-28
Onset: 2023-10-29
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-10-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3030585 / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944474 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Influenza like illness, Rash, Rash erythematous, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient called letting us know that she woke up the following morning with flu like symptoms, and red rash/hives around the neck.


VAERS ID: 1932612 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Florida  
Vaccinated: 2021-11-10
Onset: 2021-11-20
   Days after vaccination: 10
Submitted: 0000-00-00
Entered: 2021-12-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (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: Lo Loestrin Fe
Current Illness: None
Preexisting Conditions: None
Allergies: German cockroaches and dust mites. No other known allergies.
Diagnostic Lab Data:
CDC Split Type:

Write-up: I received the Moderna Booster on 11/10/2021, and on 11/20/2021, I began experiencing spontaneous urticaria (hives) throughout the day and night. The hives appear on my neck, back of my lower head, chest, stomach, head, wrists, palm of my hands, inner thighs, and bottom of my feet. The hives appear randomly over my body and last about 20 - 30 minutes, with an itching/burning sensation. I have not had any prior allergic reactions similar to this and there has been no change in my diet or environment. I began taking Allegra 24 Hour Tablets on 12/04/2021 and have seen a reduction in the hive flare ups, but I do have some still break through.


VAERS ID: 1659494 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Florida  
Vaccinated: 2021-08-24
Onset: 2021-08-24
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN ??????? / 1 OT / ID
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Immediate post-injection reaction, Incorrect route of product administration, Injection site pain, Injection site reaction, Product administered at inappropriate site, Wrong product administered
SMQs:, Drug abuse and dependence (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), 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: COVID-19 (via natural transmission)
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None as this date/time
CDC Split Type:

Write-up: Patient (my son) office visit was to receive: 1. PDD Test (TB-Bubble) 2. Influenza Seasonal QIV only. While administering the PDD Test (TB-Bubble) on his left-lower forearm (Intradermal) the NP inadvertently administered a Johnson & Johnson COVID-19 Vaccine - in the wrong location - not Intramuscular - and without request or awareness of the patient, who had already had Covid-19 (07/02/2021 - 07/09/2021). Once injected there was immediate reaction with a large rise/bubble at the injection site and high level of pain described by the patient. The NP immediate realized the deviation and informed the patient of what had occurred. The NP then proceeded to the 1. PDD Test (TB-Bubble) in the right lower forearm 2. Influenza Seasonal QIV, despite the known deviation. The NP did not provide the: Manufacture, Lot, or NDC related to the COVID-19 Vaccine for this visit (this information was excluded from his"IMMUNISATIONS Administered in the Summary of Care) The NP also refused to provide a Vaccine Card or any documentation of the event. It was until a follow-up visit to get the PPD test read that he was informed that the Manufacture of the COVID-19 Vaccine was Johnson & Johnson (but still was never provided: Lot, NDC or Vaccine Card or any documentation of the related to the COVID-19 Vaccine event). On 08/24/2021 I reported to this to pharmacy and they opened CASE. Note: They have not made contact with me and I have not been successfully in making contact with them. On 08/31/2021 I reported to this to "Johnson & Johnson" and they opened REQUEST (and J&J documented a report).


VAERS ID: 2467119 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Florida  
Vaccinated: 2022-10-01
Onset: 2022-10-01
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 064A2A / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 351657 / N/A RA / IM

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

Write-up: Patient received the Moderna booster without omicron instead of the bivalent moderna with omicorn. No adverse reactions reported.


VAERS ID: 2705385 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Florida  
Vaccinated: 2023-10-12
Onset: 2023-10-12
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 205E23A / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944481 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Immediate post-injection reaction
SMQs:, Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: The patient has experienced persistent pain in the left shoulder following the administration of this vaccine on 10/12/2023. The symptoms began immediately, and are still present as of 10/28/2023.


VAERS ID: 2467121 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Florida  
Vaccinated: 2022-10-01
Onset: 2022-10-01
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 064A22A / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 351657 / UNK - / -

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

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

Write-up: Patient received the covid 19 Moderna booster without omicron instead of bivalent Moderna booster with omicron. No adverse reaction reported.


VAERS ID: 2710308 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Florida  
Vaccinated: 2023-10-30
Onset: 2023-11-02
   Days after vaccination: 3
Submitted: 0000-00-00
Entered: 2023-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 4 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Arthritis
SMQs:, Systemic lupus erythematosus (broad), Arthritis (narrow), Tendinopathies and ligament disorders (broad), Immune-mediated/autoimmune 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: Pending
CDC Split Type:

Write-up: Systemic arthritis, joint pain. Occurred 3 days after vaccination with Flu/Moderna at same time. Has been persistent for 5 days now requiring medical attention.


VAERS ID: 2701492 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Florida  
Vaccinated: 2023-10-25
Onset: 2023-10-01
Submitted: 0000-00-00
Entered: 2023-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (NOVAVAX)) / NOVAVAX 5683MF008 / N/A LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944482 / N/A RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Feeling abnormal, Hypoaesthesia, Injection site pain, Nausea, Paraesthesia, Posture abnormal
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Dementia (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), 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: Unknown
Current Illness:
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: After receiving both vaccines on 10/25/23, during the 15min. observation time around 10:19am she was slouched down in the chair and I went over to her. She was able to communicate and said her hands were tingling and felt numb and she was breathing heavy. She said the Covid vaccine hurt a little bit going in. She gave me her mom and fathers phone number but we got answering machines for both. She said she felt funny. The assistant store manager was called and she spoke to the patient. She said she felt nauseous and EMT was contacted around 10:35am and when they arrived they took her vitals gave she was given water. She declined leaving with EMT and they left the pharmacy around 10:50am. Her father came and took her home at 11:24am.


VAERS ID: 2699666 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Florida  
Vaccinated: 2023-10-20
Onset: 2023-10-01
Submitted: 0000-00-00
Entered: 2023-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3031279 / 1 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944449 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Posture abnormal, Seizure, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Patient became faint about 5 minutes after receiving both vaccinations. She then slumped backwards in the chair and then had a small, mild seizure.


VAERS ID: 2010194 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Florida  
Vaccinated: 2022-01-05
Onset: 2022-01-05
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033H21A / 3 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308462 / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypopnoea, Mydriasis, Pallor, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (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: Fluoxetine 20 mg caps (according to patient''s profile), no other info available
Current Illness: No other illnesses by the time of vaccine as reported by patient
Preexisting Conditions: No information provided by patient about long-standing health conditions
Allergies: No known allergies to medications, food, or other products as reported by patient
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient became unresponsive around 5 minutes after receiving the shot. Patient was with her father at the moment . Patient was not responsive and presented with shallow breathing, pale skin, dilated pupils. CPR was not started because patient was breathing and had a pulse. 911 rescue services was contacted right away and instructions were given over the phone. Rescue was at the store within 10-15 min. A short time after, patient gained some grade of responsiveness and was taken to the hospital by the paramedics for further reassessment and/or treatment.


VAERS ID: 2741501 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Florida  
Vaccinated: 2023-12-12
Onset: 2023-12-12
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2024-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3031633 / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944453 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain
SMQs:, 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: FAMOTIDINE 40 MG, LOSARTAN 25 MG, MONTELUKAST 10 MG, ROSUVASTATIN 5 MG,
Current Illness: NONE
Preexisting Conditions: HIGH BLOOD PRESSURE, HIGH CHOLESTROL
Allergies: NONE
Diagnostic Lab Data: NONE. Patient recommended to see doctor
CDC Split Type:

Write-up: Patient is complaining of pain in muscle where she got the vaccine. Patient is not complaining of pain in the shoulder or limited motion of range.


VAERS ID: 1904113 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Florida  
Vaccinated: 2021-11-27
Onset: 2021-11-27
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 309622 / N/A RA / IM

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

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

Write-up: Patient was administered 0.3 mL of un-reconstituted Pfizer without dilution around 9:30 am. Upon discovery after dose had been given, pharmacist reached out to patient to see if any side effects had occurred. As of 12:30 pm that same day, patient stated none at this time so pharmacist counseled patient to monitor for any adverse effects such as excess soreness, flu-like symptoms, headache, fatigue, etc. Pharmacist encouraged patient to seek medical attention if any of those symptoms occur.


VAERS ID: 1865908 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Florida  
Vaccinated: 2021-11-08
Onset: 2021-11-08
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 32030BD / UNK - / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308460 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: hydrocodone-APAP, gabapentin, omeprazole, ondansetron, tamsulosin, temazepam
Current Illness:
Preexisting Conditions:
Allergies: penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received 2 influenza vaccines for the 2021-2022 flu season. First dose was on 8/26/21, patient then requested an influenza vaccine on 11/8/21. The pharmacy did not detect that the patient had already gotten one and administered. Patient was contacted, made aware of the situation and states he did not realize he had already gotten the influenza vaccine this season. He states he experienced no adverse effects.


VAERS ID: 2022038 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Florida  
Vaccinated: 2022-01-03
Onset: 2022-01-04
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308460 / UNK RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Nausea, Pyrexia, Sinus headache, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Headache after 2nd dose of Moderna 04/2021.
Other Medications: None
Current Illness: None, but received flu shot same time
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache around sinus area (under eyebrows and teeth), slight fever of 99.1, nausea and vomiting.


VAERS ID: 1963399 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Florida  
Vaccinated: 2021-11-26
Onset: 2021-12-02
   Days after vaccination: 6
Submitted: 0000-00-00
Entered: 2021-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308495 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac disorder, Heart rate irregular, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (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 HAD MODERNA BOOSTER DOSE 11/26/21 AND REPORTS HAVING CARDIAC ISSUES STARTING 12/2/21 DESCRIBED AS HEART "BANGS" INSTEAD OF HEART BEATS, HEART "BANGING AROUND" IN CHEST "POUNDING" STEADILY BUT FORCEFULLY UNTIL 12/17/21 AND COMPLETELY RESOLVED END OF DAY 12/18/21. SHE SPOKE TO HER DOCTOR AND DOCTOR SURMISES COULD POSSIBLY HAVE BEEN RELATED TO VACCINE / MYOCARDITIS / CARDIAC ISSUES AND TO REPORT TO PHARMACY TO REPORT TO VAERS. PATIENT HAD A FLU SHOT ON THE SAME DAY AS MODERNA BOOSTER.


VAERS ID: 2731195 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Florida  
Vaccinated: 2023-12-11
Onset: 2023-12-11
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2024-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3030540 / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370666 / N/A LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Mobility decreased, Scar
SMQs:, Parkinson-like events (broad), 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: Rosuvastatin, valsartan
Current Illness: None Reported.
Preexisting Conditions: Hypertensive heart disease without heart failure (I11.9), Pure hypercholesterolemia (E78.00)
Allergies: None Reported.
Diagnostic Lab Data: None reported,
CDC Split Type:

Write-up: Patient reported local site pain and limited range of motion after administration of two vaccines in the same arm $g3 weeks after administration. Patient completed a 5 day course of prednisone 40mg daily and is continuing to report local site soreness, pain, and limited range of motion. Patient does have scar tissue near injection site from an old skin graft. The patient reported that he has received vaccinations in that arm previously without issue. When discussing with patient, reported pain was near/associated with the scar tissue covered area.


VAERS ID: 2727079 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Florida  
Vaccinated: 2023-12-20
Onset: 2023-12-20
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HM7010 / 1 UN / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 94485 / 1 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown, only gets shots with us
Current Illness: none known
Preexisting Conditions: none known
Allergies: nka
Diagnostic Lab Data: na
CDC Split Type:

Write-up: patient broke out in a rash starting from neck and extending down through arms


VAERS ID: 1759272 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Florida  
Vaccinated: 2021-09-20
Onset: 2021-09-20
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cymbalta, effexor
Current Illness: HIV
Preexisting Conditions: HIV, high cholesterol, low testosterone, depression, anxiety
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Symptoms manifested approximately 9 hours after vaccination. Symptoms included fever, extremely severe chills and muscle ache over entire body. The symptoms lasted approximately 24 hours.


VAERS ID: 2238389 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated: 2021-11-10
Onset: 2021-11-10
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE7051 / 1 - / OT
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 340617A / UNK - / OT

Administered by: Other       Purchased by: ?
Symptoms: Facial paresis, Herpes zoster oticus, Product use issue
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Medication errors (broad), Opportunistic infections (narrow), 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? Yes, ? days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up:


VAERS ID: 2353863 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated: 2021-06-04
Onset: 2021-06-04
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 1D015A / 2 - / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Extrasystoles, Headache, Inappropriate schedule of product administration, Myalgia, Vaccination site pain, Ventricular tachycardia
SMQs:, Torsade de pointes/QT prolongation (narrow), Rhabdomyolysis/myopathy (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Eosinophilic pneumonia (broad), Tachyarrhythmia terms, nonspecific (narrow), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Hypokalaemia (broad), Noninfectious myocarditis/pericarditis (broad)

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

Write-up:


VAERS ID: 2392356 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated: 2021-11-25
Onset: 2021-11-25
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-07-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FM4289 / UNK - / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 340630A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Anxiety, Fatigue, Frequent bowel movements, Headache, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up:


VAERS ID: 2708566 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Foreign  
Vaccinated: 2023-10-05
Onset: 2023-10-05
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HG3108 / 1 - / OT
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. P100579309 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Cerebral infarction, Cerebrovascular disorder, Diplopia, Hemiataxia, Hemiparesis, Magnetic resonance imaging
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Noninfectious encephalitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Ocular motility disorders (broad), Hypoglycaemia (broad)

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

Write-up:


VAERS ID: 2447557 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Foreign  
Vaccinated: 2022-09-05
Onset: 2022-09-05
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 20003A / UNK LA / OT
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 440031A / UNK LA / OT

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure measurement, Electrocardiogram, Heart rate, Oxygen saturation, Oxygen saturation decreased, Product administration error, Syncope, Vital signs measurement
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Medication errors (narrow), Hypoglycaemia (broad), Infective pneumonia (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:


VAERS ID: 2454049 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Foreign  
Vaccinated: 2022-09-06
Onset: 2022-09-01
Submitted: 0000-00-00
Entered: 2022-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA NO BATCH NUMBER / UNK - / OT
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. NO BATCH NUMBER / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Agitation, Arthralgia, Chills, Dizziness, Lethargy, Migraine, Pain, Pyrexia, SARS-CoV-2 test
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Retroperitoneal fibrosis (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (broad)

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

Write-up:


VAERS ID: 2481580 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated: 2022-09-29
Onset: 2022-10-02
   Days after vaccination: 3
Submitted: 0000-00-00
Entered: 2022-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH GH9714 / UNK - / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 440241A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Aphasia, Cerebrovascular accident
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)

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

Write-up:


VAERS ID: 2486818 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Foreign  
Vaccinated: 0000-00-00
Onset: 0000-00-00
Submitted: 0000-00-00
Entered: 2022-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER NO BATCH NUMBER / UNK - / OT
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. NO BATCH NUMBER / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Paralysis
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (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:


VAERS ID: 2524078 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated: 2022-10-18
Onset: 2022-10-18
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH GH9852 / 4 - / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. P100479462 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Deep vein thrombosis, Off label use, Product use issue
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), 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:


VAERS ID: 2524466 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated: 2022-10-26
Onset: 2022-11-15
   Days after vaccination: 20
Submitted: 0000-00-00
Entered: 2022-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH GJ5083 / 4 - / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. P100474962 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Alanine aminotransferase increased, Analgesic drug level therapeutic, Aspartate aminotransferase increased, Blood alkaline phosphatase increased, Cardiac failure, Gamma-glutamyltransferase increased, Hepatitis fulminant, Serology test, Transaminases, Troponin increased
SMQs:, Cardiac failure (narrow), Liver related investigations, signs and symptoms (narrow), Hepatitis, non-infectious (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Myocardial infarction (narrow), Biliary system related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Noninfectious myocarditis/pericarditis (broad)

Life Threatening? Yes
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: TERBASMIN [TERBUTALINE SULFATE]; ALDACTONE [SPIRONOLACTONE]; SEGURIL; ELIQUIS; JARDIANCE; HIBOR; XUMADOL; LORAZEPAM; BISOPROLOL FUMARATE; ESOMEPRAZOLE; RIVOTRIL; ALPRAZOLAM; FERBISOL; ATORVASTATIN; TRANGOREX; VANDRAL; ZOLAFREN
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up:


VAERS ID: 2614821 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated: 2022-09-24
Onset: 2022-09-24
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / UNK - / OT
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 451991111 / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Foetal exposure during pregnancy, Large for dates baby
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Neonatal disorders (narrow)

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

Write-up:


VAERS ID: 2613563 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated: 2023-01-16
Onset: 2023-01-01
Submitted: 0000-00-00
Entered: 2023-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH GH9852 / 4 - / OT
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. P100481685 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Akathisia, Dysmetria, Hypertension
SMQs:, Neuroleptic malignant syndrome (broad), Akathisia (narrow), Noninfectious encephalitis (broad), Hypertension (narrow)

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

Write-up:


VAERS ID: 2560495 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Foreign  
Vaccinated: 0000-00-00
Onset: 0000-00-00
Submitted: 0000-00-00
Entered: 2023-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (NOVAVAX)) / NOVAVAX - / UNK RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / UNK LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Nausea, Troponin
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: CETIRIZINE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Reaction to previous exposure to any vaccine
Allergies:
Diagnostic Lab Data: Test Date: 20221219; Test Name: Troponins; Result Unstructured Data: Normal
CDC Split Type: AUNOVAVAX, INC.2023NVXAU0

Write-up: Chest pain; Dyspnoea; Nausea; On 20-DEC-2022, a serious, initial Regulatory Authority safety report was received from a physician, via a Regulatory Centre, via Regulatory Administration (RA reference number: AU-TGA-0000762486), via Biocelect and was received by Novavax on 12-JAN-2023. A 44 year-old female of an unspecified race was vaccinated with intramuscular Nuvaxovid 10 ug/mL suspect Covid-19 vaccine unspecified dose on 19-DEC-2022 at 10:00 in the right deltoid. The following secondary suspect medication was reported: intramuscular Flucelvax (influenza vaccine inact sag 3v) on 19-DEC-2022 at 10:00 in the left deltoid. It was reported the individual has had Reaction to previous exposure to any vaccine, unspecified vaccine and reaction. No additional medical history was reported. The following concomitant medication was reported: Cetirizine, received pre-vaccination on 19-DEC-2022 at 08:00. On 19-DEC-2022, 10 minutes post-vaccination, the individual experienced nausea (PT: Nausea) (Serious: Medically Significant). Additionally, 23 minutes post-vaccination, the individual experienced severe 8/10 chest tightness (PT: Chest pain) (Serious: Hospitalization and Medically Significant) & dyspnea (PT: Dyspnoea) (Serious: Medically Significant). It was reported that management for the events included "Hospital admission" for Chest pain and "Hospital emergency department" for Dyspnoea. Relevant lab tests included: Troponin (Result: Normal; 19-DEC-2022). At the time of reporting, the event outcomes of Chest pain and Dyspnoea were recovered/resolved and event stop date was 19-DEC-2022, reportedly improved by around 21:00. The event oucome of Nausea was recovered/resolved and event stop date was 19-DEC-2022. The Regulatory Administration'' narrative was provided as follows: 0800 pre-vax cetirizine 1000 novavax IM R deltoid, flucelvax IM L deltoid 10 mins post vaccines, onset nausea 23mins post vaccines, onset severe 8/10 chest tightness & dyspnea Chest pain lasted for hours ADDED from Mgt of Event unstructured: Outcome is known. Further details as provided: Reviewed in ED : troponins normal Observed in Short Stay: chest pain and dyspnoea improved by ~2100, discharged home Previous vaccine reactions: Yes V2201-061594 RA assessed the causality between the vaccine and reported events as possible.; Sender''s Comments: This 44 year-old female experienced: Chest pain, Dyspnoea and Nausea after vaccination with Nuvaxovid 10 ug/mL. The events Chest pain, Dyspnoea and Nausea were reported as serious. Based on the spontaneous nature of the report, the causal relationship between Nuvaxovid and the reported events is considered Possible.


VAERS ID: 2552287 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Foreign  
Vaccinated: 2021-11-03
Onset: 2021-11-04
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH NO BATCH NUMBER / UNK - / OT
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. NO BATCH NUMBER / UNK - / OT
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH NO BATCH NUMBER / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Leukopenia, Lymphopenia
SMQs:, Haematopoietic leukopenia (narrow), Systemic lupus erythematosus (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up:


VAERS ID: 2541022 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated: 2022-11-23
Onset: 2022-11-23
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH GH9741 / 4 - / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. P100483663 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Computerised tomogram, Electromyogram, Guillain-Barre syndrome, Magnetic resonance imaging, Off label use, Product use issue
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), Medication errors (broad), Immune-mediated/autoimmune 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? Yes, ? days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up:


VAERS ID: 2541828 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated: 2022-11-04
Onset: 2022-11-04
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH GH9722 / 4 - / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. P100481112 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Malaise, Off label use, Palpitations, Product use issue
SMQs:, Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), 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? Yes, ? days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: PAROXETINE; METFORMIN
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up:


VAERS ID: 2541829 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated: 2022-10-21
Onset: 2022-10-21
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH GH9852 / 4 - / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. P100480518 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Off label use, Pericarditis, Product use issue, Specialist consultation
SMQs:, Systemic lupus erythematosus (broad), Chronic kidney disease (broad), Medication errors (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), Noninfectious myocarditis/pericarditis (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? Yes, ? days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up:


VAERS ID: 2157355 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Foreign  
Vaccinated: 2021-10-18
Onset: 2021-10-18
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2382 / UNK - / OT
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 340616B / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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

Write-up:


VAERS ID: 1838085 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated: 2021-10-14
Onset: 2021-10-18
   Days after vaccination: 4
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / UNK - / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. NO BATCH NUMBER / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Bedridden, Dizziness, Impaired work ability, Nausea, Vestibular neuronitis, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Paracetamol
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up:


VAERS ID: 1887081 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated: 2021-11-06
Onset: 2021-11-06
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK0112 / 3 - / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Cold sweat, Immunisation, Maternal exposure during pregnancy, Off label use, Pallor, Product use issue, SARS-CoV-2 test, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Hypotonic-hyporesponsive episode (broad), Medication errors (broad), Hypoglycaemia (broad), COVID-19 (broad)

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

Write-up:


VAERS ID: 1922317 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Foreign  
Vaccinated: 2021-11-16
Onset: 2021-11-16
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-12-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH NO BATCH NUMBER / UNK - / OT
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. NO BATCH NUMBER / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Chills, Migraine, Nausea
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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up:


VAERS ID: 1926510 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Foreign  
Vaccinated: 2021-11-16
Onset: 2021-11-17
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2021-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH NO BATCH NUMBER / UNK LA / OT
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. NO BATCH NUMBER / UNK RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Back pain, Chills, Disturbance in attention, Feeling hot, Headache, Hyperaesthesia, Malaise, Musculoskeletal stiffness, Nausea, Neck pain, Vaccination site pain
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up:


VAERS ID: 1940774 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated: 2021-11-20
Onset: 2021-11-20
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Immunisation, Pain, Product use issue, SARS-CoV-2 test
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Medication errors (broad), COVID-19 (broad)

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

Write-up:


VAERS ID: 1946323 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Foreign  
Vaccinated: 2021-03-12
Onset: 2021-11-23
   Days after vaccination: 256
Submitted: 0000-00-00
Entered: 2021-12-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3004732 / 3 - / OT
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER1741 / 1 - / OT
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Headache, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)

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

Write-up:


VAERS ID: 1977125 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Foreign  
Vaccinated: 2021-12-01
Onset: 2021-12-01
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK9413 / 3 - / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Anaphylactic reaction, Immunisation, Interchange of vaccine products, Off label use, Pharyngeal erythema, Pharyngeal swelling, Product use issue
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Medication errors (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up:


VAERS ID: 1990881 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Foreign  
Vaccinated: 2021-11-17
Onset: 2021-11-01
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH NO BATCH NUMBER / UNK LA / OT
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. NO BATCH NUMBER / UNK RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Blood pressure measurement, Decreased appetite, Dizziness, Epistaxis, Fatigue, Headache, Heart rate, Heart rate increased, Myalgia, Nausea, Oxygen saturation, Oxygen saturation decreased, Pyrexia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (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: Metformin; Omeprazol; Ramipril
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up:


VAERS ID: 1996636 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Foreign  
Vaccinated: 2021-11-01
Onset: 2021-11-04
   Days after vaccination: 3
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 1F1009A / UNK - / OT
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 340621A / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Facial paralysis
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (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:


VAERS ID: 1996638 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Foreign  
Vaccinated: 2021-11-25
Onset: 2021-11-30
   Days after vaccination: 5
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3005687 / UNK - / OT
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 3079781A / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Cutaneous vasculitis
SMQs:, Severe cutaneous adverse reactions (narrow), Vasculitis (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

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

Write-up:


VAERS ID: 2012696 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Foreign  
Vaccinated: 0000-00-00
Onset: 0000-00-00
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER NO BATCH NUMBER / UNK - / OT
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. NO BATCH NUMBER / UNK - / OT

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

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

Write-up:


VAERS ID: 2067388 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated: 2021-10-10
Onset: 2021-10-10
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG6273 / 3 LA / OT
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Body temperature, Bone pain, Hypothermia, Immunisation, Infection, Nasal congestion, Nasopharyngitis, Oropharyngeal pain, SARS-CoV-2 test, Throat irritation
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Accidents and injuries (broad), Osteonecrosis (broad), COVID-19 (broad)

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

Write-up:


VAERS ID: 2096581 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Foreign  
Vaccinated: 2021-10-21
Onset: 2021-11-10
   Days after vaccination: 20
Submitted: 0000-00-00
Entered: 2022-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH9678 / UNK - / OT
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 3079451B / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Pneumonia
SMQs:, Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-16
   Days after onset: 6
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:


VAERS ID: 2136354 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Foreign  
Vaccinated: 2021-12-13
Onset: 2021-12-14
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2022-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH NO BATCH NUMBER / UNK - / OT
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. NO BATCH NUMBER / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Abortion spontaneous, Exposure during pregnancy, Histology
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (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? Yes, ? days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up:


VAERS ID: 2141406 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Foreign  
Vaccinated: 2021-10-18
Onset: 2021-10-18
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2382 / UNK - / OT
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 340616B / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Lymphadenopathy, Malaise, Myalgia, Vaccination site pain
SMQs:, Rhabdomyolysis/myopathy (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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:


VAERS ID: 2215328 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Foreign  
Vaccinated: 2021-10-13
Onset: 2021-10-13
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2382 / 3 - / OT
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 340616B / UNK - / OT

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Malaise, Product use issue
SMQs:, Guillain-Barre syndrome (broad), 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:


VAERS ID: 2157361 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Foreign  
Vaccinated: 2021-10-18
Onset: 2021-10-18
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2382 / 3 - / OT
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. UNKNOWN / UNK - / OT

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Product use issue, Pyrexia, Vaccination site pain
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Medication errors (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up:


VAERS ID: 2157368 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Foreign  
Vaccinated: 2021-10-13
Onset: 2021-10-13
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2382 / UNK - / OT
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. NO BATCH NUMBER / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Body temperature, Myalgia, Pyrexia, Vaccination site pain
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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:


VAERS ID: 2159272 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Foreign  
Vaccinated: 2021-10-20
Onset: 2021-10-20
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2382 / 3 - / OT
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 340617B / UNK - / OT

Administered by: Other       Purchased by: ?
Symptoms: Vaccination site pain
SMQs:

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

Write-up:


VAERS ID: 2178721 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated: 2021-10-22
Onset: 2021-10-22
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2382 / 3 - / OT
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 340617B / UNK - / OT

Administered by: Other       Purchased by: ?
Symptoms: Myalgia, Off label use, Product use issue, Pyrexia, Vaccination site pain
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Medication errors (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up:


VAERS ID: 2178722 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Foreign  
Vaccinated: 2021-10-20
Onset: 2021-10-20
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2382 / 3 - / OT
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 340617B / UNK - / OT

Administered by: Other       Purchased by: ?
Symptoms: Myalgia, Off label use, Product use issue, Vaccination site pain
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), 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:


VAERS ID: 2178724 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated: 2021-10-12
Onset: 2021-10-12
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2382 / 3 - / OT
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 340616B / UNK - / OT

Administered by: Other       Purchased by: ?
Symptoms: Pyrexia, Vaccination site pain
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? 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:


VAERS ID: 2181067 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated: 2021-10-18
Onset: 2021-10-18
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2382 / 3 - / OT
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 340616B / UNK - / OT

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Insomnia, Irritability, Malaise, Nervousness, Off label use, Product use issue, Pyrexia, Somnolence, Vaccination site pain
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Medication errors (broad), 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? 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:


VAERS ID: 2183253 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated: 2021-10-19
Onset: 2021-10-19
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2382 / 3 - / OT
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 340617B / UNK - / OT

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Headache, Malaise, Myalgia, Off label use, Product use issue, Vaccination site pain
SMQs:, Rhabdomyolysis/myopathy (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), 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:


VAERS ID: 2183255 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated: 2021-10-19
Onset: 2021-10-19
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2382 / 3 - / OT
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 340617B / UNK - / OT

Administered by: Other       Purchased by: ?
Symptoms: Nausea, Product use issue, Rash
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Medication errors (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up:


VAERS ID: 2183257 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Foreign  
Vaccinated: 2021-10-22
Onset: 2021-10-22
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2382 / 3 - / OT
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 340617B / UNK - / OT

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Malaise, Off label use, Product use issue, Vaccination site pain
SMQs:, Guillain-Barre syndrome (broad), 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:


VAERS ID: 2197859 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Foreign  
Vaccinated: 2021-10-14
Onset: 2021-10-14
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC2382 / UNK - / OT
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 340616B / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Headache, Lymphadenopathy, Malaise, Vaccination site pain
SMQs:, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up:


VAERS ID: 2197860 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated: 2021-10-15
Onset: 2021-10-15
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2382 / 3 - / OT
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 340617B / UNK - / OT

Administered by: Other       Purchased by: ?
Symptoms: Off label use, Product use issue, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Medication errors (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up:


VAERS ID: 2205773 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Foreign  
Vaccinated: 2021-10-19
Onset: 2021-10-19
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2382 / 3 - / OT
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 340616B / UNK - / OT

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Headache, Insomnia, Myalgia, Pyrexia, Vaccination site pain
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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:


VAERS ID: 2212643 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Foreign  
Vaccinated: 2021-10-15
Onset: 2021-10-01
Submitted: 0000-00-00
Entered: 2022-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2382 / UNK - / OT
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 340616B / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Malaise
SMQs:, Guillain-Barre 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up:


VAERS ID: 2716639 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Georgia  
Vaccinated: 2023-11-21
Onset: 2023-11-01
Submitted: 0000-00-00
Entered: 2023-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3032261 / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370666 / 1 - / IM

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

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

Write-up: Patient was given Flucelvax instead of Spikevax on accident. Patient stated he had already received flu vaccine in October of this month


VAERS ID: 1734682 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Georgia  
Vaccinated: 2021-09-25
Onset: 2021-09-25
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 309614 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: not known
Current Illness: none reported
Preexisting Conditions: none reported
Allergies: none known to patient
Diagnostic Lab Data: Fire Department and ambulance arrived and was helping patient.
CDC Split Type:

Write-up: After 5 to 10 minutes of receiving vaccines, she lost consciousness, woke up and went into seizures for duration less than a minute. Emergency Medical Services was contacted; however, patient refused to go to the hospital.


VAERS ID: 1940493 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Georgia  
Vaccinated: 2021-12-06
Onset: 2021-12-06
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045J21A / UNK - / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308495 / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising, Injection site pain, Injection site pruritus
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), 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: bee stings, pollen, estrogen
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt had arm pain, bruise, itching at site of injection. took ibuprofen to help with pain


VAERS ID: 2694228 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Georgia  
Vaccinated: 2023-10-10
Onset: 2023-10-10
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HF9275 / 5 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370666 / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Chills, Diarrhoea, Headache, Injection site pain, Lethargy, Musculoskeletal stiffness, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Dystonia (broad), Parkinson-like events (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (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), Arthritis (broad), Noninfectious diarrhoea (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prozac 40mg, Adderall 30mg
Current Illness: None.
Preexisting Conditions: None.
Allergies: Allergic to sulfa antibiotics. They give me a high fever.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Gastrointestinal upset - diarrhea 3-4 times between 2:00-6:30PM on 10/10/23. Pain at injection site (left arm) began around 11:00PM on 10/10/23. Fever, chills, body aches, headache, stiff neck, extreme lethargy all began somewhere between 11:00 PM (10/10/23) and 1:00 AM (10/11/23) and continued through 11AM 10/11/23 despite taking Tylenol around 8:00 AM (10/11/23). Symptoms have gotten better since 11AM; however, I am still very lethargic, have a bit of a headache, and low-grade body aches. Injection site is still sore, but not nearly as bad as it was over night.


VAERS ID: 1929158 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Georgia  
Vaccinated: 2021-12-07
Onset: 2021-12-07
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5124 / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 309622 / N/A RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, 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), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Medication errors (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 Pediatric Pfizer dose in left deltoid. She then received Flucelvax in right deltoid. Upon receipt of 2nd vaccine, patient fainted and lost consciousness for a few seconds. She quickly woke up, had a snack, and recovered.


VAERS ID: 2722569 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Georgia  
Vaccinated: 2023-10-08
Onset: 2023-10-09
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Brain fog, Mental impairment, Oral herpes
SMQs:, Dementia (broad), Oropharyngeal infections (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Opportunistic infections (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: Immune disease treatment: Hydrocortisone, fludrocotisone, levoxyl. Plus sertrsline.
Current Illness: None
Preexisting Conditions: Autoimmune endocrine deficiency, Herpes type 1 (cold sores), MDS-RARS, Sideroblastic anemia
Allergies: Penicillins, phenargen
Diagnostic Lab Data: Self-measured with thermometer
CDC Split Type:

Write-up: High fever 102.9 degrees next day Recurring high fevers every 2-3 weeks since then Widespread herpes coldsore outbreak Mental fog, slower mental processing


VAERS ID: 2709485 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Georgia  
Vaccinated: 2023-10-20
Onset: 2023-10-20
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3030498 / 1 LA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944482 / 1 RA / SYR

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

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

Write-up: NO adverse event


VAERS ID: 2687013 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Georgia  
Vaccinated: 2023-09-20
Onset: 2023-09-21
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HH7595 / 4 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944478 / UNK LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arrhythmia, Electrocardiogram abnormal, Supraventricular tachycardia
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Noninfectious myocarditis/pericarditis (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: Sulfa drugs (rash), seafood (GI distres)
Diagnostic Lab Data: EKG via KardiaMobile on 9/22/23 showed HR of 202 bpm and irregular rhythm which resembles SVT.
CDC Split Type:

Write-up: 2 episodes of SVT, lasting <5 minutes, able to use vagal maneuver to exit; did not seek care at health facility. Occurred 9/21/23 around 10:30 am, and 2nd episode happened around 6:30 pm on 9/22/23.


VAERS ID: 1821326 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Georgia  
Vaccinated: 2021-10-15
Onset: 2021-10-18
   Days after vaccination: 3
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 - / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308481 / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Hypoaesthesia, Inappropriate schedule of product administration
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Sexual dysfunction (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: Hydrocloraquin; nexium; valsarten
Current Illness:
Preexisting Conditions:
Allergies: penicillin; codeine; ceftin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received the flu shot in my right arm, covid booster in my left. I have been having shoulder pain and numbness from my shoulderblade, down my arm and even in my pinky and ring finger.


VAERS ID: 2440136 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Georgia  
Vaccinated: 2022-09-08
Onset: 2022-09-11
   Days after vaccination: 3
Submitted: 0000-00-00
Entered: 2022-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH GH9694 / N/A LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH GH9694 / N/A LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 0322 / N/A LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 0322 / N/A RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, 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: Protein powder
Current Illness: None
Preexisting Conditions: None
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chills 12 hrs after injection while asleep, , subsided by morning. Swollen lymph node under arm, left side


VAERS ID: 2730494 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Georgia  
Vaccinated: 2024-01-08
Onset: 2024-01-08
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2024-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HM7006 / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944474 / 1 LA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS 324B2 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Presyncope
SMQs:, Anticholinergic syndrome (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: Vasovagal reaction with every vaccine
Other Medications: Vilazodone 40 mg
Current Illness: None
Preexisting Conditions:
Allergies: KNDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had a vasovagal reaction. He fainted for 10 seconds. He was conscious before we could move him or measure his blood pressure.


VAERS ID: 2695192 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Iowa  
Vaccinated: 2023-10-11
Onset: 2023-10-12
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AU3833D / 1 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944484 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Lymphadenopathy
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received the annual flu shot and new Spikevax covid vaccine on 10/11/23. Patient called the pharmacy on 10/12/23 and asked to speak to someone about the vaccines she had received. The patient asked the pharmacist if having chest pain and swelling of the lymph nodes the day after getting vaccines was normal. The pharmacist told her we sometimes see flu-like symptoms for a day or two after getting these vaccines but if she is having chest pain we would recommend getting medical attention. Pharmacist enquired if there were any other factors that could have caused this, such as physical exertion, exercise or other illness. Patient said nothing out of the ordinary. Pharmacist reaffirmed getting medical attention. Patient did not seem very concerned and said that was all the info she needed for now.


VAERS ID: 2522223 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Iowa  
Vaccinated: 2022-10-20
Onset: 0000-00-00
Submitted: 0000-00-00
Entered: 2022-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061F22A / 4 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 7+ LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Arthritis, Splint application, Tendonitis, X-ray limb abnormal
SMQs:, Systemic lupus erythematosus (broad), Osteonecrosis (broad), Arthritis (narrow), Tendinopathies and ligament disorders (narrow), Immune-mediated/autoimmune 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: Multivitamin
Current Illness: N/A
Preexisting Conditions: Knee Arthritis
Allergies: Penicillin; Pollen
Diagnostic Lab Data: 11/22/2022, Thumb X-ray, Tendonitis and Arthritis
CDC Split Type: vsafe

Write-up: I started having gradual pain in the joint in my right thumb that became very severe. I couldn?t pick up a cup without it hurting. I went into the doctor, and they x-rayed the thumb and found arthritis that haven?t been there before. They also found tendonitis and prescribed prednisone. They recommend me to splint it, ice it, and warm compress. I still wear the splint, but it is a little better. I tried not to wear the splint one day and it got worse, so I keep it on.


VAERS ID: 1928586 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Iowa  
Vaccinated: 2021-12-06
Onset: 2021-12-06
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308496 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Seizure
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Patient received both shots and then a few minutes later she fell backwards. A nurse in the waiting room felt she suffered 2 (5 minute) seizures. After she fell she was awake and coherent . An ambulance was called and transported her to emergency room.


VAERS ID: 2689139 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Iowa  
Vaccinated: 2023-10-01
Onset: 2023-10-01
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH H7595 / N/A RA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 373589 / N/A LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Adverse reaction, Blood test, Chest X-ray, Chest pain, Electrocardiogram, Hypertension, Hypoaesthesia, Pain in extremity, Troponin
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data: Medical results pending. Including ekg, bloodwork, chest xray, troponin levels and repeat troponin. Full vital monitoring (high blood pressure), initial troponing (prior to 6 hrs post vaccine negative) . Repeat troponin pending. No chest ct or mri
CDC Split Type:

Write-up: Individual experienced acute adverse reaction approximately 20 minutes after dual administration of flucevax and comirnaty (biotech/pfizer) monovalent injections were administered. Flucevax quadrivalent PF injection was administered into left arm, biotech/pfizer) monovalent injection was administered in right arm. Approximately 20 minutes post vaccination, individual experienced acute chest pain in the lower left chest side, that rapidly intensified along with sharp pain in the left arm and complete numbness of his left arm. Immediately went to ER for treatment as individual indicated he thought he may be having a heart attack.


VAERS ID: 2579746 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Female  
Location: Idaho  
Vaccinated: 2022-10-24
Onset: 2022-10-24
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FT1551 / 3 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. FT1551 / 1 LA / IM

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: Abreva 10% cream 1 app apllied topically 5 time a day.
Current Illness: No.
Preexisting Conditions: No.
Allergies: N.K.D.A.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Patient received a Pfizer Monovalent booster instead of a bivalent booster. Patient''s dad informed of the immunization error. Dad states patient did not have an adverse reaction to the vaccine.


VAERS ID: 2536844 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Male  
Location: Idaho  
Vaccinated: 2022-10-17
Onset: 0000-00-00
Submitted: 0000-00-00
Entered: 2022-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FT1551 / 3 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 348379 / 1 LA / IM

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

Write-up: I gave the monovalent instead of the bivalent dose to this patient. There was not adverse reaction. I just need to give the bivalent dose to this patient now.


VAERS ID: 2579980 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Idaho  
Vaccinated: 2022-10-13
Onset: 0000-00-00
Submitted: 0000-00-00
Entered: 2023-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FP7150 / 5 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. P-348359 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect product formulation administered, No adverse event, Vaccination 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: Contacted patient 2/10 around 1812, patient informed of error and states no adverse reactions to immunization from time of administration to time of contact. Patient has no concerns for any treatment in regards to immunization error.


VAERS ID: 2528383 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Idaho  
Vaccinated: 2022-12-08
Onset: 2022-12-08
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 018C22A / 5 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 348381 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Escitalopram 10 mg daily Levothyroxine 88 mcg daily
Current Illness: None
Preexisting Conditions: Anxiety/Depression, Headaches/Migraines, Thyroid
Allergies: Wellbutrin XL
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Given Moderna Vaccine booster dose only Pediatric dose - Not Moderna Adult Omnicrom


VAERS ID: 2699093 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: Idaho  
Vaccinated: 2023-10-19
Onset: 2023-10-19
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 8057658 / 3 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370648 / 7+ LA / SYR

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

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

Write-up: Moderna for 12+ given to a 10 year old. Parent informed, encouraged to watch for extra side effects and call or have the child be seen if have any concerns. Parent reported child was doing fine at time of call; had been about 2 hours since shot administration.


VAERS ID: 2699090 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Male  
Location: Idaho  
Vaccinated: 2023-10-19
Onset: 2023-10-19
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 8057658 / 3 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370648 / 6 LA / IM

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

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

Write-up: Moderna for 12+ given to a 5 year old. Parent informed, encouraged to watch for extra side effects and call or have the child be seen if have any concerns. Parent reported child was doing fine at time of call; had been about 2 hours since shot administration.


VAERS ID: 2510451 (history)  
Form: Version 1.0  
Age: 64.0  
Sex: Male  
Location: Idaho  
Vaccinated: 2022-11-01
Onset: 0000-00-00
Submitted: 2022-11-01
Entered: 2022-11-15
   Days after submission: 14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FP7150 / 4 LA / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 348359 / 1 LA / -
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C5882AA / 1 RA / -

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

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

Write-up: None stated.


VAERS ID: 1783769 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Illinois  
Vaccinated: 2021-10-13
Onset: 2021-10-13
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308444 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

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

Write-up: Gave both vaccines flu and covid, one in each arm at about 8 pm. 10 minutes later, patient had trouble breathing. Administered Epipen. Patient started to breathe better after epipen. Fire department came and assessed her. Went home on her own.


VAERS ID: 1954710 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Illinois  
Vaccinated: 2021-12-10
Onset: 2021-12-10
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD7218 / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308491 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Interchange of vaccine products, Wrong product administered
SMQs:, Medication errors (narrow)

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

Write-up: pt came in requesting a flu shot and received a pfizer covid booster. she was previously vaccinated with moderna, a flu shot was then also given, pt was monitored for adverse reactions. none reported.


VAERS ID: 1789489 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Illinois  
Vaccinated: 2021-10-13
Onset: 2021-10-15
   Days after vaccination: 2
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / N/A 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: Cetirizine 10 mg
Current Illness:
Preexisting Conditions: Asthma, kidney stone history
Allergies: Sulfa drugs, latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Painful, swollen lymph nodes in underside of left arm, and left armpit.


VAERS ID: 2696257 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Male  
Location: Illinois  
Vaccinated: 2023-10-15
Onset: 2023-10-15
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HE2391 / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944494 / 1 RA / IM

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

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

Write-up: The child stated he felt dizzy and nauseous after receiving both vaccines. He also started to sweat profusely. I offered him water and had him sit down. He started to feel better after a few minutes of sitting. No signs of an anaphylactic reaction were present. I called 911 just in case. The paramedics checked his vitals and everything normal. He was okay to stand up and walk around.


VAERS ID: 2609878 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Illinois  
Vaccinated: 2022-10-26
Onset: 2023-01-01
   Days after vaccination: 67
Submitted: 0000-00-00
Entered: 2023-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030G22B / 4 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 348373 / 1 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Eye laser surgery, Retinal tear, Visual impairment
SMQs:, Anticholinergic syndrome (broad), Accidents and injuries (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Corneal disorders (broad), Retinal disorders (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lexapro; Wellbutrin; Multivitamin; Ibuprofen
Current Illness: N/A
Preexisting Conditions: Mild Asthma; Endometriosis; Arthritis
Allergies: Clindamycin; CT contrast
Diagnostic Lab Data: 09FEB2023 Physical exam
CDC Split Type: vsafe

Write-up: Around the end of January 2023, I started getting a black spot in my vision on my right eye and it would dance around. I spoke to my primary doctor, and she referred to the eye clinic. Teh eye clinic diagnosed me with a retinol tear. They had to a laser treatment around the area to ensure it didn''t tear further. I''m still in the recovery process. I will have to see them a couple times this year and then yearly visits after that. Still have the dark spot but it is stable for now.


VAERS ID: 2696867 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Illinois  
Vaccinated: 2023-10-15
Onset: 2023-10-16
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 8057459 / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944487 / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Fatigue, Feeding disorder, Migraine, Nausea, Pain, Pain in extremity, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: body aches and pain, fatigue
Other Medications: Vitamin D3 1000 IU Norethindrone Metformin 500mg
Current Illness: I had a cold the week before
Preexisting Conditions: PCOS
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: The evening of 10/15, I experienced arm pain and had a migraine. The next morning, I was fatigued, had a sore arm, feeling of tightness in the chest, whole body aches, and nausea that was severe enough that I was unable to eat all day. All these symptoms continued throughout the day, and in the afternoon (about 24 hours after being vaccinated), I began to vomit. Though I felt better after, the nausea persisted for the rest of the evening.


VAERS ID: 2711282 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Illinois  
Vaccinated: 2023-11-07
Onset: 2023-11-07
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HG4434 / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 373589 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immediate post-injection reaction, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (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 reported tingling in her arm right after the covid vaccine, patient also received a flu vaccine in the same arm immediately after the covid vaccine. She described no issues in range of motion of her shoulder, just a tingling sensation similar to when one''s arm has that "falling asleep" feeling


VAERS ID: 2710863 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Illinois  
Vaccinated: 2023-11-04
Onset: 2023-11-04
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 205E23A / N/A RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944494 / N/A LA / IM
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. W011264 / N/A RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS 9HR72 / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Feeling cold, Lethargy, Nervousness
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: Adderall, lamotrigine, Fluoxetine. OTC usage is unknown
Current Illness: None reported
Preexisting Conditions: ADHD, depression, anxiety
Allergies: No known drug allergies
Diagnostic Lab Data: Vital signs
CDC Split Type:

Write-up: Patient received 4 vaccines and after a few minutes started feeling, week, shaky, cold and lethargic. She was advised to sit down. She was given water and a cold pack was applied to the back of the neck. After 10 minutes, she was still feeling the same, so 911 was called. Paramedics came and assessed the patient. Vital signs were normal. She started feeling better so paramedics did not take her to the hospital. She was advised not to drive herself so she contacted a family member and she was picked up. We tried to follow up with her a few days later but she didn''t respond to our call.


VAERS ID: 2696992 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Illinois  
Vaccinated: 2023-10-15
Onset: 2023-10-16
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA SPIKEVAX / 5 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain, Injection site warmth
SMQs:, 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: Prenatal, vit d, allegra
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin, latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Red spot, warm to touch, sore with pressure


VAERS ID: 1981597 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Illinois  
Vaccinated: 2021-12-22
Onset: 2021-12-22
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Axillary pain, Feeling cold, Hyperhidrosis, Injected limb mobility decreased, Insomnia, Lymphadenopathy, Neck pain, Pain, Pain in extremity
SMQs:, Neuroleptic malignant syndrome (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: I experienced soreness in the arm where I received the vaccines the night I got them. The pain was excruciating and I could not lift or move my arm that night and I also could not sleep. My entire body was sweating and then I was freezing and couldn''t get warm. I experienced soreness for the next 3 days. My armpit was very sore as well. On day 4, I notice a lump/swelling in my armpit with pain in my shoulder and radiating up to the left side of my neck. The soreness of the arm has subsided, but the lump in my underarm has not.


VAERS ID: 1916559 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Illinois  
Vaccinated: 2021-11-24
Onset: 2021-11-24
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (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: Adderall XR, Duloxetine, Omeprazole 20mg, Flonase, Vitamin B Complex, Multivitamin
Current Illness: Migraine, received Moderna booster at the same time.
Preexisting Conditions: Migraine, ADHD, LPR
Allergies: Intolerance to visible egg in food. Allergic rash bacitracin.
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: The flu vaccine gave me bruises on my right arm. There''s still significant bruising 8 days after receiving the vaccine.


VAERS ID: 2699821 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Illinois  
Vaccinated: 2023-10-19
Onset: 2023-10-20
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 80777-0102-96 / N/A LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 70461-0323-03 / UNK LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Massage, Nausea, Pain in extremity, Presyncope
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Montelukast, Trintellix, Ritual men?s vitamin
Current Illness: None
Preexisting Conditions: General anxiety and possible weak vasovagal response.
Allergies: No known
Diagnostic Lab Data: At the time I was at physical therapy for cubital tunnel syndrome, receiving a massage on my right arm that was painful. I had limited six hours of sleep previously and no breakfast yet at the time. PT had me lie down for about 45 minutes with sips of water and Gatorade.
CDC Split Type:

Write-up: Almost fainted with feelings of lightheadedness, queasy stomach and light headache.


VAERS ID: 2700259 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Illinois  
Vaccinated: 2023-10-14
Onset: 2023-10-14
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 205E23A / N/A LA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944480 / N/A LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Injected limb mobility decreased, Injection site pain, Loss of personal independence in daily activities, Pain, Therapeutic product ineffective
SMQs:, Lack of efficacy/effect (narrow), Retroperitoneal fibrosis (broad), Dementia (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: Hydrochlorothiazide 25 mg Losartan 100 mg Amlodipine besylate 5 mg Atorvastatin 10 mg Estradiol vaginal cream
Current Illness: None
Preexisting Conditions: High blood pressure, high cholesterol
Allergies: None
Diagnostic Lab Data: None yet.
CDC Split Type:

Write-up: Starting at night of the day I got the vaccines: upper arm and shoulder very painful/achy. I could not raise my arm at all. A week later I can move and raise my arm a little. Still very painful especially when lying down and when using my arm for anything, like getting dressed or carrying anything. Pain now includes my back (back pain is probably caused by me trying to sleep in a position that keeps my shoulder from hurting). I have never had a problem with a vaccine before. I know this is early, only nine days but it seems like it is not improving at all. I need to know what to tell my doctor so she can send me to right person to help and so that I don''t make things worse like I am with sleeping position. I''ve tried ibuprofen and naproxen but they don''t really help.


VAERS ID: 1813297 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Illinois  
Vaccinated: 2021-10-23
Onset: 2021-10-23
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308464 / N/A RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness, Cold sweat, Dizziness, Feeling cold, Feeling hot, Hyperhidrosis, Immediate post-injection reaction, Lethargy, Mydriasis, Pallor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: SECONDS AFTER RECEIVING BOTH VACCINATIONS PATIENT STARTED TO COMPLAIN OF DIZZINESS. AFTER A FEW MINUTES HE STARTED TO SWEAT PROFUSELY AND STATED HE WAS HOT. PT GOT VERY PALE AND PUPILS BECAME VERY DILATED. PATIENT STATED HE COULDN''T SEE (NO SPOTS, JUST BLACKNESS). 911 WAS CALLED AND EMS DISPATCHED. PT WAS VERY LETHARGIC, HAD TO KEEP HIM TALKING SO HE DIDN''T PASS OUT. AFTER ~20 MINUTES PT. COLOR CAME BACK, PUPILS RETURNED TO NORMAL AND VISION WAS IMPROVING, NO LONGER COLD/CLAMMY. EMS CHECKED PT OUT AND HE WENT HOME UNDER HIS OWN POWER.


VAERS ID: 2690339 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Illinois  
Vaccinated: 2023-10-01
Onset: 2023-10-02
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Injection site erythema, Injection site mass, Injection site swelling, Malaise, Mass, Pain
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: Malaise and headache, age 50, February 2021, covid vaccine by Moderna
Other Medications: Levothyroxine, cetirizine, Flonase, escitalopram
Current Illness: N/A
Preexisting Conditions: Lymphedema, Hypothyroidism, hay fever, anxiety, depression
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Left arm: swelling, lump, and redness surrounding injection area beginning 12 hours post injection and continuing with a broader redness area by 48 hrs. At 17 hours post injection: severe headache and general malaise and fatigue, lasting 24 hours. 48 hrs post injection, swelling and a painful lump in left clavicle region noted. Currently at 56 hours post injection: still swollen painful left arm with a knot and redness; still painful lump and swelling in left clavicle region


VAERS ID: 2702263 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Illinois  
Vaccinated: 2023-10-21
Onset: 2023-10-24
   Days after vaccination: 3
Submitted: 0000-00-00
Entered: 2023-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3032169 / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. UNKNOWN / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Influenza like illness, Pain, Pain in jaw, Poor quality sleep
SMQs:, Depression (excl suicide and self injury) (broad), Osteonecrosis (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: normal symtoms as described in previous section
Other Medications: Taladafil 5 mg daily
Current Illness: None
Preexisting Conditions: None
Allergies: Iodine contrast
Diagnostic Lab Data: None
CDC Split Type:

Write-up: COVID Vaccination Sequence 1st Dose COVID vaccination: 24-Mar-2021 (Moderna Lot 008B21A) 2nd Dose COVID vaccination: 21-Apr-2021 (Moderna Lot 001C21A) Booster COVID vaccination: 24-Nov-2021 (Moderna Lot 058H21A) Booster COVID vaccination: 21-Oct-2023 (Spikevax 12+ Moderna Lot 3032169) This was the first time I had the shot combined with the flu shot. Same as with the first 3 COVID vaccinations I felt very tired and "flu-ish", had a slight headache and couldn''t sleep well, but the first time I did not get nauseous like I did with the first three shots. On the evening of Tu, 24-Oct-2023 (all other symptoms had resided), I had a sudden onset of pain in my left jaw joint, which still persists today at the time of this report. Chewing still causes significant pain. I am reporting this based on some medical reports I found online earlier today that it could potentially relate to the COVID vaccine.


VAERS ID: 2689460 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Illinois  
Vaccinated: 2023-09-27
Onset: 2023-09-27
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 5 LA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aphonia, Brain fog, Energy increased, Fatigue, Pericoronitis
SMQs:, Noninfectious encephalopathy/delirium (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: sumatriptan 100mg robinul 4mg junel 1.5/30 ibuprofen doxepin 50mg
Current Illness:
Preexisting Conditions: chronic migraine
Allergies: mild allergy to latex, usually resultant in a rash or itching that resolves within an hour
Diagnostic Lab Data:
CDC Split Type:

Write-up: At around 6pm, 4 hours after receiving the vaccines, I experienced about 30 minutes of significantly increased energy. At around 6:30pm, extreme fatigue set in that has continued through today, Monday, October 2. On Friday, September 29, the fatigue increased substantially and I had trouble staying awake. I began to lose my voice, and experienced pericoronitis, or swelling or the tissue around my right molars. Throughout this entire time, I have had significant brain fog and an inability to think clearly. These symptoms are beginning to resolve after several days of rest.


VAERS ID: 2687210 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Illinois  
Vaccinated: 2023-09-24
Onset: 2023-09-25
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3030368 / 4 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944487 / 1 LA / IM

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

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

Write-up: Redness, swelling, and tenderness on left arm near the vaccine site (but not where it was administered). Symptoms started around 12 hours and has persisted to now (3 days after vaccination).


VAERS ID: 2493753 (history)  
Form: Version 1.0  
Age: 40.0  
Sex: Unknown  
Location: Illinois  
Vaccinated: 2022-10-27
Onset: 0000-00-00
Submitted: 0000-00-00
Entered: 2022-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH GI2524 / 2 - / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 351694 / 2 - / IM

Administered by: Other       Purchased by: Public
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: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt came in with two kids, I thought they were all getting COVID and flu turned out this pt had the covid vaccine already


VAERS ID: 2698241 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Illinois  
Vaccinated: 2023-10-17
Onset: 2023-10-18
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 210F23-2A / 4 - / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370656 / N/A - / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Influenza like illness, Myalgia, Taste disorder, Temperature regulation disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Taste and smell disorders (narrow), Eosinophilic pneumonia (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: Lexapro, Propranolol, Ritalin
Current Illness: No
Preexisting Conditions: Primary Sclerosing Cholangitious Migraines Tourettes Sydrome Depression/Anxiety
Allergies: No
Diagnostic Lab Data: No
CDC Split Type:

Write-up: Aside from already reported s8de effects such as muscle aching, feeling flu like, inability to regulate temperature, their is a terrible taste I. My mouth that started about 24 hours after getting the shots.


VAERS ID: 1905354 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Illinois  
Vaccinated: 2021-11-27
Onset: 2021-11-29
   Days after vaccination: 2
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012H21B / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308454 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lymphadenopathy, Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Hives after moderna 1st shot 2/12/21; not reported
Other Medications: Prenatal vitamin, kan dietary supplement gather vitality, natures bounty hair skin and nails
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Left under arm swollen painful lymph nodes, high fever of 102 and 103 appearing 8 hours after injection; hives on chest below breasts and in between breasts appearing early morning of 11/29/21.


VAERS ID: 1848708 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Indiana  
Vaccinated: 2021-11-04
Onset: 2021-11-05
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 RA / IM

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

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

Write-up: Sore left arm, fever, myalgia


VAERS ID: 1843288 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Indiana  
Vaccinated: 2021-11-04
Onset: 2021-11-04
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 077C21B / 1 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308520 / UNK LA / IM

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

Write-up: The patient was administer the moderna vaccine after the expired time allow on the punctured vial.


VAERS ID: 2709380 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Indiana  
Vaccinated: 2023-10-27
Onset: 2023-10-28
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 8059068 / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370674 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dehydration, Diarrhoea, Hypersomnia, Loss of consciousness, Malaise
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), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad), Dehydration (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: Shot taken on Friday October 27. Saturday slept most of the day and several bouts of explosive diarrhea. Sunday felt a little better and more diarrhea. Monday didn''t feel good and ended up passing out from dehydration and went to er for fluids.


VAERS ID: 2696189 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Indiana  
Vaccinated: 2023-10-13
Onset: 2023-10-14
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3031281 / 1 - / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 372395 / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Small dose aspirin Zyrtec Ziac 2.5/6.25 Diovan 160 mg
Current Illness: N/A
Preexisting Conditions: N/A (some higher than usual blood pressure after getting covid last year.
Allergies: Penicylin and sulfa
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Fever, chills, body aches fatigue


VAERS ID: 1952658 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Indiana  
Vaccinated: 2021-12-14
Onset: 2021-12-14
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3594 / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308498 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Fatigue, Mood altered
SMQs:, Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pfizer COVID shot (1st dose 4/29/2021 and 2nd was on 5/20/2021 Lot#EW0182). He was 40 at time of both vaccines. He became very m
Other Medications: None.
Current Illness: N/A
Preexisting Conditions: Narcolepsy, Sleep apnea
Allergies: Sulfa, Aspirin, Ceclor
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Received the Pfizer shot first at clinic. After this shot (his booster), he became very tired. His moods were immediately different, too. He became more moody and temperament/demeanor was different, overall. Everything seemed to get worse over a 24 hour timeframe- from the time he received this injection. * When he had past injections of the same Pfizer COVID 19 shot, his moods were like this, too. However, we did not think to report the events. He also tried to get the Flu shot, and they said no (due to no appointments). So he went to another facility, and received his Flu shot, the same day, too (I didn?t know how to document that on the previous page).


VAERS ID: 2699754 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Indiana  
Vaccinated: 2023-10-17
Onset: 2023-10-18
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 4 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Exposure during pregnancy, Fatigue, Feeling of body temperature change, Nausea, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Hypoglycaemia (broad)

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

Write-up: 4 weeks pregnant (unknown at the time) Shakey, nauseous, weak, fatigued, no fever, hot/cold chills Lasted 12 hours


VAERS ID: 2696033 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Indiana  
Vaccinated: 2023-10-13
Onset: 2023-10-13
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HD9835 / 1 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 374407 / 1 LA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS M7YY5 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? 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 had syncope, put cold rags on neck and gave him some water. About 15 minutes he was fine.


VAERS ID: 1932677 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Indiana  
Vaccinated: 2021-12-01
Onset: 2021-12-01
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-12-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 330308D / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308477 / N/A RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Adverse reaction
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: prednisone 10 mg, azithromycin 250 mg tablets, escitalopram 20 mg, pantoprazole 40 mg, gabapentin 100 mg, montelukast 10 mg, ipratropium 0.06% nasal spray,
Current Illness: Unknown.
Preexisting Conditions: Affective psychosis.
Allergies: Norco 10-325 mg tablets, percocet 10-325 mg tablets, diphtheria toxoid contain vaccines, tetanus toxoids. Per note on rx, patient was tested for 35 allergies and tested positive for 33 allergies. All allergies unknown.
Diagnostic Lab Data: Unknown. The pharmacy was not given lab values from when the patient reported to the emergency room.
CDC Split Type:

Write-up: Patient was okay when she left our store. The patient was not having a reaction at that time, so emergency services were not notified. Later, around 5 pm, the patient''s husband called our store to inform us that the patient was having a reaction and was reporting to the emergency room to evaluated. We were not provided with further information.


VAERS ID: 2417373 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Indiana  
Vaccinated: 2022-08-19
Onset: 2022-08-19
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Decreased appetite, Night sweats, 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin 325 mg
Current Illness: nq
Preexisting Conditions: nq
Allergies: na
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt reports Sx''s began later Friday, same day after receiving COVID and FLU vaccine. Pt reports a loss of appetite, fever chill, body aches. Pt reports all Sx''s have subsided since, however still experiencing night sweats x 3 days.


VAERS ID: 2542863 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Indiana  
Vaccinated: 2022-09-21
Onset: 2022-03-01
Submitted: 0000-00-00
Entered: 2022-12-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH GJ5342 / 6 UN / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / N/A UN / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Biopsy breast abnormal, Intraductal proliferative breast lesion, Mammogram abnormal, Mammogram normal, Nipple exudate bloody, Ultrasound scan abnormal, Ultrasound scan normal
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Breast malignant tumours (narrow), Breast tumours of unspecified malignancy (broad), Non-haematological malignant tumours (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: Levothyroxine Rosuvastatin Amlodipine/Benazepril caps Potassium Hydrochlorothiazide Metformin Farxiga Tylenol Calcium citrate magnesium zinc combination D3 Biotin Emergen-C Metamucil (sugar free) Culturelle probiotics with prebiotics Baby A
Current Illness: None
Preexisting Conditions: Hypertension Pre-Diabetes High Cholesterol HypoThyroidism Low Potassium Arthritis
Allergies: Demerol Zofran
Diagnostic Lab Data: May 2022: Mammogram and ultrasound was negative December 2022: Mammogram and ultrasound of left breast indicated possible breast cancer December 2022: Biopsy of suspicious area indicated positive for Ductal Carcinoma In Situ (DCIS) Stage 0 December 2022: MRI of both breasts -- awaiting results as of this date December 2022: Genetic testing -- awaiting results as of this date
CDC Split Type:

Write-up: Initial symptom occurred in March 2022: small amount of spontaneous bleeding from left breast nipple Further testing in April and June did not indicate a cause or diagnosis Follow-mammogram on December 5, 2022 revealed possible breast cancer Biopsy on December 8, 2022 confirmed Ductal Carcinoma In Situ (DCIS) Stage 0 Treatment has not begun as of this date (12/25/22)


VAERS ID: 2515822 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Indiana  
Vaccinated: 2022-11-15
Onset: 2022-11-15
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (NOVAVAX)) / NOVAVAX G56796 / 4 RA / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 70461032203 / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ageusia, Nasopharyngeal swab, Off label use, Product use issue
SMQs:, Taste and smell disorders (narrow), 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: SERTRALINE; CLONAZEPAM; XYZAL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Anxiety
Allergies:
Diagnostic Lab Data: Test Date: 20221118; Test Name: Nasal Swab; Test Result: Negative ; Comments: Nasal Swab
CDC Split Type: USPFIZER INC202201313418

Write-up: I have lost my sense of taste.; Flucelvax quad: 15Nov2022, Pfizer Dose 4: 15Nov2022; Flucelvax quad: 15Nov2022, Pfizer Dose 4: 15Nov2022; This is a spontaneous report received from contactable reporter(s) (Consumer or other non HCP). The reporter is the patient. A 51-year-old female patient (not pregnant) received BNT162b2, BNT162b2 omi ba.4-5 (BNT162B2, BNT162B2 OMI BA.4-5), on 15Nov2022 at 10:00 as dose 4 (booster), single (Lot number: G56796) at the age of 51 years, in right arm for covid-19 immunisation; influenza vaccine inact sag 4v (FLUCELVAX QUAD), on 15Nov2022 as dose 1, single (Lot number: 70461032203), in left arm for immunisation. The patient''s relevant medical history included: "General Anxiety" (unspecified if ongoing). Concomitant medication(s) included: SERTRALINE; CLONAZEPAM; XYZAL. Vaccination history included: BNT162b2 (Dose Number: 1, Batch/Lot No: Unknown. Looks like ER8737, Location of injection: Arm Right), administration date: 05Apr2021, when the patient was 50-year-old, for COVID-19 Immunization; BNT162b2 (Dose Number: 2, Batch/Lot No: Unknown. Looks Looks like, EW0173, Prev dose vaccine location= Right arm), administration date: 05May2021, when the patient was 50-year-old, for Covid-19 immunization; BNT162b2 (Dose Number: 3, Batch/Lot No: Unknown. Looks like, FK or HC then 9893, Location of injection: Arm Right), administration date: 08Apr2022, when the patient was 51-year-old, for COVID-19 Immunization. The following information was reported: OFF LABEL USE (non-serious), PRODUCT USE ISSUE (non-serious) all with onset 15Nov2022, outcome "unknown" and all described as "Flucelvax quad: 15Nov2022, Pfizer Dose 4: 15Nov2022"; AGEUSIA (non-serious) with onset 17Nov2022 at 15:00, outcome "not recovered", described as "I have lost my sense of taste.". Relevant laboratory tests and procedures are available in the appropriate section. Therapeutic measures were not taken as a result of ageusia. Additional information: Prior to the vaccination, the patient was not diagnosed with COVID.


VAERS ID: 1936411 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Indiana  
Vaccinated: 2021-12-04
Onset: 2021-12-05
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2021-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. UNKNOWN / N/A RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Discomfort, Dizziness, Fatigue, Head discomfort, Hypoaesthesia, Muscle spasms, Muscle twitching, Paraesthesia, Sleep disorder, Taste disorder
SMQs:, Peripheral neuropathy (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Dyskinesia (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), 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: Venlafaxine 150, Vitamin d2 50000 iu, mono-linyah
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Around 2:00 am, around 7 hours after receiving vaccinations, I started having severe muscle spasms and twitching. I felt extremely uneasy and weak. Even though my head felt extremely heavy and tired, I could not fall back asleep. My body felt the complete opposite as if it was full of energy. This lasted until about 5 am when I was finally able to go back to sleep. No other reactions occurred until today 12/09 around 7 am when I woke up my whole body felt numb and I felt a tingling sensation all over. It got worse the more I moved. It would travel up to my head and make me feel unsteady where my hearing would start to fade. I felt like I was going to faint multiple times. A few times my head would shake as if I was trying to mimic getting a bad taste out of my mouth. It is now 4:00 pm on the same day and I am still experiencing these side effects. The slightest movement makes my head feel uneasy.


VAERS ID: 2548207 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Kansas  
Vaccinated: 2023-01-02
Onset: 2023-01-02
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AR6965B / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 348384 / N/A RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
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.


VAERS ID: 2684965 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Kansas  
Vaccinated: 2023-09-21
Onset: 2023-09-21
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HD9835 / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944453 / 1 LA / IM
VARZOS: ZOSTER (SHINGRIX) / GLAXOSMITHKLINE BIOLOGICALS 9277T / 1 RA / IM

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: patient stated after the imz has passed out with imz and blood draws before
Other Medications: unknown
Current Illness: none reported
Preexisting Conditions: none reported
Allergies: no known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient passed out after receiving the vaccine


VAERS ID: 2692748 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Kansas  
Vaccinated: 2023-10-02
Onset: 2023-10-02
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 209F23A / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944484 / 1 RA / IM

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

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

Write-up: Patient fainted after vaccines while watching other family members get the vaccine. He did fall into a wall and and hit his head and then fell to the floor, but quickly regained consciousness. Out of caution, he was transported to a local ER for evaluation.


VAERS ID: 2720784 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Kansas  
Vaccinated: 2023-10-17
Onset: 2023-10-18
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-12-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AU3833D / 6 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 37164 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Haematoma, Injection site swelling, Pain, Peripheral swelling, Reaction to previous exposure to any vaccine
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations: He received the flu and Bivalent moderna vaccine on 10/10/2022 and had swelling of his arm and bruising, but that went down.
Other Medications: Atorvastatin 10mg, Olmesartan 10mg, Warfarin 5mg, Trospium 20mg, Multivitamin
Current Illness: No
Preexisting Conditions: Afib
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt stated that his right arm started to swell a day after he got the shot and grew 3 times as big. This swelling continued down his shoulder to his wrist. He got a painful haematoma and the swelling is still there. He is being treated for the pain.


VAERS ID: 2548178 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Kansas  
Vaccinated: 2023-01-02
Onset: 2023-01-02
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AR6965B / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 348384 / UNK RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
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.


VAERS ID: 2688714 (history)  
Form: Version 2.0  
Age: 1.83  
Sex: Female  
Location: Kentucky  
Vaccinated: 2023-09-28
Onset: 2023-09-28
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 8057456 / 1 RL / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370648 / 1 LL / IM

Administered by: Public       Purchased by: ?
Symptoms: Incorrect 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: Acetaminophen, Cetirizine HCl, Ibuprofen, Polyethylene Glycol
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Provider wrote order for COVID-Moderna 0.25 ml 6mo-11yrs. Medical Assistant administered COVID-Moderna Spikevax 0.5 ml for ages 12 and up No adverse reactions at time of report. Contacted manufacture (Case Number) and was instructed to report case to VAERS. RN and MA notified patient''s father at 99/28/230 3:48 p.m. via interpreter. (Patient and father''s IDs were verified.) Per patient''s father, the patient is normal. MA called patient''s father again (09 29/23) at 2:30 p.m. No interpreter. (Patient and father''s IDs were verified.) Per patient''s father, "she (patient) is doing really good."


VAERS ID: 1876971 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Kentucky  
Vaccinated: 2021-10-26
Onset: 2021-11-09
   Days after vaccination: 14
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 066D21A / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Antinuclear antibody, Arthritis, C-reactive protein, Full blood count, Hypoaesthesia, Immunology test, Paraesthesia, Red blood cell sedimentation rate, Rheumatoid factor, Vitamin B12
SMQs:, Peripheral neuropathy (broad), Systemic lupus erythematosus (broad), Guillain-Barre syndrome (broad), Arthritis (narrow), Immune-mediated/autoimmune disorders (broad), Sexual dysfunction (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: Sectral 200mg PO BID HCTZ 12.5mg PO qAM Estrogen 1mg PO qAM Bentyl 20mg PO QID ASA 81mg PO qAM Trintellix 10mg PO qAM Wellbutrin XL 300mg PO qAM Seroquel 50mg PO qHS Simvastatin 20mg PO qHS Claritin 10mg PO qAM Protonix 40mg PO qAM
Current Illness: No illnesses present
Preexisting Conditions: COPD; CHF; Depression; Anxiety; HTN; Tachycardia; POTS; GERD; IBS C/D; PTSD; Endometriosis; Fibrocystic breasts; Seasonal Allergies; Hx of elevated d-dimer; hyperlipidemia; hx of low vitamin D
Allergies: NKDA NKA
Diagnostic Lab Data: Still awaiting lab results from the following: B12, CBC/diff, RA factor, Sed rate, Nuclear Antigen Antibody, IFA and C-reactive protein
CDC Split Type:

Write-up: Approximately two weeks after the Covid vaccination, I woke up with left hand 4th and 5th digit numbness/tingling. Also half of my left hand numb/tingles. I thought I had slept on it wrong, but after it was continuing for a few days, I contacted my doctor. I had my appointment yesterday, 11/16/21. I had not considered the vaccine as being a culprit until she asked which arm I had the booster in. We are checking vitamin levels as well as inflammation levels (to check for RA or OA) and I am currently wearing a brace on the left wrist to assist with decreased inflammation. We are trying to rule out other issues before considering this to be a vaccination injury. As of today, the numbness and tingling continue to occur throughout the day, with full feeling to the finger tips not returning since the initial incident occurred. I am also a registered nurse, so I know sign/symptoms to be looking for and my doctor and I are both hoping for a simple explanation instead of it being vaccination related. I am still awaiting lab results (labs were obtained yesterday, 11/16 for B12, CBC/diff, RA factor, Sed rate, Nuclear Antigen Antibody, IFA and C-reactive protein). I am currently taking Advil, Flexeril and applying a wrist brace while sleeping and when repetitive use may occur.


VAERS ID: 1753334 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Kentucky  
Vaccinated: 2021-09-29
Onset: 2021-09-29
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308435 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anion gap normal, Basophil count normal, Basophil percentage, Blood calcium decreased, Blood chloride normal, Blood creatinine normal, Blood glucose normal, Blood potassium normal, Blood sodium normal, Blood urea increased, Carbon dioxide decreased, Chills, Condition aggravated, Differential white blood cell count, Dyspnoea, Eosinophil count normal, Eosinophil percentage, Extra dose administered, Feeling cold, Full blood count normal, Haematocrit normal, Haemoglobin normal, Immature granulocyte count, Lymphadenopathy, Lymphocyte count normal, Lymphocyte percentage decreased, Mean cell haemoglobin concentration normal, Mean cell haemoglobin normal, Mean cell volume normal, Mean platelet volume increased, Metabolic function test normal, Monocyte count normal, Monocyte percentage, Musculoskeletal stiffness, Neutrophil count normal, Neutrophil percentage increased, No reaction on previous exposure to drug, Pain, Platelet count normal, Red blood cell count normal, Red cell distribution width normal, Seizure, Tremor, Vaccination complication, White blood cell count increased
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Anaphylactic reaction (broad), Haematopoietic leukopenia (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Convulsions (narrow), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (broad), Arthritis (broad), Tumour lysis syndrome (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: after the first dose mild symptoms
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data: CBC and Metabolic Panel ED Provider Notes MD at 9/29/2021 11:51 PM Chief Complaint Patient presents with ? Other family said pt was "convulsing" in bed and SOB. Had second COVID and flu shot today The patient is a 58-year-old female who presents by squad for evaluation of shaking. She tells me that she got an influenza immunization in her right arm and the COVID-19 booster shot in her left arm. This is her third COVID-19 vaccine. She has not had COVID-19 infection in the past. She got the shots at 11:00 this morning. She states that she was fine all day with exception of some soreness in her arms from the immunizations. She went to take the dog for a walk this evening and felt like her right leg locked up. She describes that she couldn''t flex or extend very well, but nonetheless got back into the house. She states that she started having coarse shaking of both arms and both legs. The paramedics described that she was awake, alert and talking, but having shaking of both her upper and lower extremities. Eventually she stopped shaking. She denies having a fever today, but feels cold. She did not have any previous reactions to her first 2 COVID-19 vaccines. She currently feels much better. She states that she has never had a panic attack before and has not been under a lot of stress today. Patient History No Known Allergies Home Medications: Prior to Admission medications Not on File Past Medical History: Past Medical History: Diagnosis Date ? Renal stones Social History: reports that she has never smoked. She has never used smokeless tobacco. She reports current alcohol use. She reports being sexually active and has had partner(s) who are male. She reports that she does not use drugs. E-Cigarettes (such as Vapes or Juul) Family History: Family History Problem Relation Age of Onset ? Cancer Mother colon ? Cancer Maternal Grandmother lung ? Cancer Maternal Grandfather lung ? Cancer Maternal Aunt breast ? Diabetes Paternal Grandmother Surgical History: Past Surgical History: Procedure Laterality Date ? OTHER SURGICAL HISTORY 6/21/11 No surgeries Review of Systems Review of Systems All other systems reviewed and are negative. Physical Exam There were no vitals taken for this visit. Physical Exam Vitals and nursing note reviewed. Constitutional: General: She is not in acute distress. Appearance: She is well-developed. HENT: Head: Normocephalic and atraumatic. Eyes: Conjunctiva/sclera: Conjunctivae normal. Pupils: Pupils are equal, round, and reactive to light. Cardiovascular: Rate and Rhythm: Normal rate and regular rhythm. Heart sounds: No murmur heard. No friction rub. No gallop. Pulmonary: Effort: Pulmonary effort is normal. Breath sounds: Normal breath sounds. Abdominal: General: There is no distension. Palpations: Abdomen is soft. Tenderness: There is no abdominal tenderness. Musculoskeletal: General: Normal range of motion. Cervical back: Normal range of motion and neck supple. Comments: Normal range of motion of the upper and lower extremities. No drift with straight arm raises. Lymphadenopathy: Cervical: No cervical adenopathy. Skin: General: Skin is warm and dry. Findings: No rash. Neurological: General: No focal deficit present. Mental Status: She is alert. Cranial Nerves: No cranial nerve deficit. Comments: The patient is awake and alert. No cranial nerve deficits. No dysarthria or aphasia. No resting or intention tremor of the upper or lower extremities. Psychiatric: Mood and Affect: Mood normal. Procedures Radiology/EKG/Labs: Results for orders placed or performed during the hospital encounter of 09/29/21 CBC WITH DIFF Result Value Ref Range WBC 10.4 (H) 3.7 - 10.3 x10(3)/mcL RBC 4.62 3.90 - 5.20 x10(6)/mcL Hgb 14.2 11.2 - 15.7 g/dL Hct 42.5 34.0 - 45.0 % MCV 92.0 80.0 - 100.0 fL MCH 30.7 26.0 - 34.0 pg MCHC 33.4 30.7 - 35.5 g/dL RDW 14.0 <=14.9 % Platelet 230 155 - 369 x10(3)/mcL MPV 11.0 8.8 - 12.5 fL Neut Percent 75.1 % Imm Gran% 0.3 % Lymph Percent 17.0 % Mono Percent 5.2 % Eos Percent 1.9 % Baso Percent 0.5 % Neut # 7.8 (H) 1.6 - 6.1 x10(3)/mcL IMMGRAN# 0.0 0.0 - 0.1 x10(3)/mcL Lymph # 1.8 1.2 - 3.9 x10(3)/mcL Mono # 0.5 0.3 - 0.9 x10(3)/mcL Eos# 0.2 0.0 - 0.5 x10(3)/mcL Baso # 0.1 0.0 - 0.1 x10(3)/mcL BASIC METABOLIC PANEL Result Value Ref Range Sodium 137 136 - 145 mmol/L Potassium 3.9 3.5 - 5.0 mmol/L Chloride 104 98 - 107 mmol/L Total CO2 19 (L) 22 - 29 mmol/L Anion Gap 14 7 - 16 mmol/L Calcium 8.9 8.6 - 10.4 mg/dL Glucose Lvl 108 (H) 74 - 100 mg/dL BUN 24 (H) 6 - 20 mg/dL Creatinine 0.83 0.51 - 1.30 mg/dL GFR Afr Am 90 $g=60 mL/min/1.73 m2 GFR Non Afr Am 78 $g=60 mL/min/1.73 m2 ED Course: Appropriate laboratory and radiology studies reviewed Patient presents after having her right leg "lock up." She also describes having shaking of her arms and legs. She is not having any symptoms at this time. It''s unclear what caused her symptoms. The patient''s sister came out to find me at the nurse''s station and reported that the patient was shaking again. The patient was lying on her side with twitching of her upper and lower extremities rhythmically. She was awake and would talk with me. When I had her hold out her arms, the movements stopped. Her sister wonders if the patient has a functional movement disorder. It is more likely that she has an adverse reaction to the vaccines today. Her temperature initially was 99.8. She was given Tylenol 1 g by mouth. Repeat temperature was 100.2. She was observed and her temperature improved. She requested discharge and was sent home. She was told to take Motrin and Tylenol regularly for her symptoms. ED Clinical Impression: 1. Adverse reaction to COVID-19 vaccine Critical Care time Condition at Discharge/Transfer from Department: Stable This chart was completed using voice recognition technology and may contain unintended errors MD 09/30/21 0321
CDC Split Type:

Write-up: At approximately 9:30pm I became chilled and experienced overall body ache. Later when taking my dog out my right leg locked up and once I got into bed I began convulsing, could not breath and was unable to communicate with my husband. Initially the paramedics felt it was a panic attack. Vital signs, CBC and Metabolic panel showed no abnormal results. Medical Center ER doc also initially indicated he also suspected a panic attack, however conceded it was possibly an adverse reaction. I spent 9-31-2021 resting and on 10-1 feel back to normal. I do not believe it was a panic attack. After the first dose of the Pfizer vaccine (EL9269) I was aware of underarm gland swelling. Now after the third dose it is more pronounced.


VAERS ID: 2481861 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Kentucky  
Vaccinated: 2022-10-16
Onset: 2022-10-16
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AR6965B / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 942431 / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect product formulation administered, Underdose, Wrong 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received the incorrect vaccine. Pt was given Moderna Pediatric Monovalent NDC 80777-275-99 instead of Moderna Bivalent Booster NDC 80777-0282-05


VAERS ID: 2519882 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Kentucky  
Vaccinated: 2022-11-21
Onset: 2022-11-25
   Days after vaccination: 4
Submitted: 0000-00-00
Entered: 2022-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH GJ3277 / 4 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 942410 / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Death
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad), Noninfectious myocarditis/pericarditis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NA
Preexisting Conditions: Profound ID and Ataxia
Allergies: PCN
Diagnostic Lab Data:
CDC Split Type:

Write-up: SUDDEN CARDIAC ARREST THEN DEATH


VAERS ID: 1839626 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Kentucky  
Vaccinated: 2021-11-02
Onset: 2021-11-02
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Injection site pruritus, Injection site urticaria, Pain
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (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: Losartan 50mg daily, Claritin 10mg daily.
Current Illness: N/A
Preexisting Conditions: Obesity, High Blood Pressure, Depression & Anxiety
Allergies: Sulfa medications. None other known.
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Half dollar sized hive with itching at site of Covid 19 booster injection. Fatigue and mild body aches.


VAERS ID: 2707958 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Female  
Location: Louisiana  
Vaccinated: 2023-10-24
Onset: 2023-10-25
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AU5509B / 1 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 373068 / UNK LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Nausea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: PATIENT HAD NAUSEA, FEVER, VOMITING WAS TAKEN TO URGENT CARE 2 TIMES


VAERS ID: 1729087 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Louisiana  
Vaccinated: 2021-09-15
Onset: 2021-09-15
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 2 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308443 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Fatigue, Feeding disorder, Illness, Injection site reaction, Injection site warmth, Insomnia, Pain, Pain in extremity, Pyrexia, Toothache
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall (10mg). Flu Vaccine at same time as 2nd COVID vaccine (Moderna).
Current Illness: None.
Preexisting Conditions: Seasonal allergies.
Allergies: Only seasonal; dust, pollen, grass.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Worst reaction/sickness I''ve ever had due to a vaccine or illness. Fever begin around 6pm, and continued to increase into the late night. Around 2:00am, fever reached 103.2*F. The injection sites for COVID on my left are felt like a contact sport injury to the muscle, and the skin felt like the worse sunburn I''ve ever had. I couldn''t wear a shirt, and rolling over in bed hurt. I have never experienced joint pain in my life, and this was almost debilitating. The pain was excruciating and included my fingers, knuckles, hands, elbows, kneecaps, ankles and hips. I''m an athlete and workout; I''ve never before felt anything like this in these areas. It felt like how elderly people describe arthritis. My skull has never hurt that bad from anything other than a physical injury. The range of painfulness was equal to the area covered by a combat pilot''s visor. (For the range, take your thumbs to your temple, connect your index finger tips over your head, and rotate down until you''ve reached your eyebrows). All of my top teeth were in agony. My bottom teeth did not hurt at all. Could not eat of drink. Did not sleep (was up in weird dream-wake state for 24 hours). Contacted PI, who is MD/PhD. She suggested I don''t do anything until after 48 hours. At 24 hours after reaction began, I took 3 Ibuprofen on the regular, every 4 hours. After the first dose, the fever began to decline (103.2 down to 102.5). Next morning fever broke. Skull has ached since the injection, and I''m extremely exhausted.


VAERS ID: 2692887 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Louisiana  
Vaccinated: 2023-10-09
Onset: 2023-10-09
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HG4633 / UNK RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944498 / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immediate post-injection reaction, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: LOCALIZED SWELLING. PATIENT TOOK 2 IBUPROFEN THAT SHE HAD. WE PROVIDED WATER. PATIENT SAT IN IMMUNIZATION ROOM FOR 10 MINUTES. SWELLING BEGAN TO REDUCE. PATIENT SAT IN LOBBY FOR AN ADDITIONAL 10 MINUTES. I PROVIDED HER WITH A 25MG BENADTYL TO TAKE ONCE SHE GOT HOME. PATIENT WAS CONTACTED BY PHONE AT 4:30PM AND SHE STATED THAT SHE IS OKAY. SWELLING OCCURRED WITH THE FLUCELVAX VACCINATIONATION INSTANTLY


VAERS ID: 2738303 (history)  
Form: Version 2.0  
Age: 4.0  
Sex: Female  
Location: Massachusetts  
Vaccinated: 2023-11-27
Onset: 2023-11-28
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2024-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AU5551B / UNK - / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. DC49G / UNK - / -
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. X019555 / UNK - / -
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER 34MF9 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Immunisation reaction
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Encntr for routine child health exam w/o abnormal findings; Encounter for immunization
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Postvaccination fever on 2023-11-28.


VAERS ID: 2096722 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Massachusetts  
Vaccinated: 2022-01-07
Onset: 2022-01-14
   Days after vaccination: 7
Submitted: 0000-00-00
Entered: 2022-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001J21A-2A / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308496 / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Skin disorder, 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: omeprazole cetirizine
Current Illness: none
Preexisting Conditions: none
Allergies: no known allergies
Diagnostic Lab Data: Pending
CDC Split Type:

Write-up: Pt said he noticed "bump" approx one week after immunization but not sure of exact date. Pt said he continued to play sports/work out and he thinks the physical activity may have exacerbated it and caused the skin to break. I physically looked at the bump and today it looks like a circular raised area approx dime-sized with inverted red center (appears to be under the skin) Pt said it was not painful until the skin kept re-breaking making the area worse. I told pt to check in with his regular doctor to see what to do next. Bump was located in in the very upper area of shoulder about an inch from collar bone so unsure if this was caused by the immunization or a separate issue (ex. spider/insect bite, infected follicle, cyst) the site is far above where injections have been regularly administered by same rph.


VAERS ID: 1925034 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Massachusetts  
Vaccinated: 2021-12-03
Onset: 2021-12-03
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033H21A / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308446 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Extra dose administered, Inappropriate schedule of product administration, Injection site erythema, Injection site pain, Injection site pruritus, Injection site swelling, Pyrexia, SARS-CoV-2 test
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: had mild adverse reaction after 2nd dose of Moderna vaccine, including some swelling and fever
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: penicillin
Diagnostic Lab Data: pt had COVID 19 disease after receiving 2 doses of vaccine. Dx in August 2021
CDC Split Type:

Write-up: received both seasonal flu and Moderna COVID 19 booster. the patient c/o fever beginning late the same day/early am of the next day. fever continued for an additional day. 102 at the highest. also c/o of swelling, itch and redness at injection site of the COVID 19 vaccine ( left arm), no c/o regarding the right arm ( seasonal flu). my assessment today (12/6) showed a marked pinkish color and some swelling at injection site. pt stated the area was still itchy and somewhat painful to touch.


VAERS ID: 2724365 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Massachusetts  
Vaccinated: 2023-12-15
Onset: 2023-12-15
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 8059072 / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. AU3129B / N/A RA / IM

Administered by: Work       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: N/A
CDC Split Type:

Write-up: Moderna Spikevax mRNA Vaccine was administered on 12/15/23. Thaw-out sticker on packaging expiration date is 12/13/23. No adverse reaction; no treatment needed. Moderna to be notified for any further recommendations.


VAERS ID: 2724371 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Massachusetts  
Vaccinated: 2023-12-15
Onset: 2023-12-15
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 8059072 / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. AU3129B / N/A RA / IM

Administered by: Work       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: N/A
CDC Split Type:

Write-up: Moderna Spikevax was administered on 12/15/23. The thaw-out expiration sticker is 12/13/23. No adverse reaction noted. No medical treatment necessary. Moderna to be contacted for any further recommendations.


VAERS ID: 2727690 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Massachusetts  
Vaccinated: 2023-12-14
Onset: 2023-12-14
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HF9300 / N/A RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944494 / N/A LA / IM

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

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

Write-up: I vaccinated the patient with a COVID vaccine followed by a Flucelvax vaccine in their right and then left arm, respectively. Shortly after I put a band-aid on her arm, she told me she was feeling dizzy. I told her to sit back in her chair and take a deep breath. She very shortly lost consciousness so I just supported her body and called for help. Another customer in the store was a nurse and heard my call for help and came to my aid followed by my pharmacy co-workers. The patient was very sweaty and because of the way her arms were cinching and stiffing up I was concerned she was having a seizure. The nurse called 911. The patient eventually came to and told us she hadn''t eaten that day nor had she had much to drink. We gave her some water and a small sucker. She said she didn''t want the paramedics to come so we gave her the phone to talk with the dispatcher in order to cancel the call. We then called her parents to come and pick her up. She is a college kid home for the holidays. I waited with her until her dad arrived. When he arrived he said it was probably a vasovagal response as he is prone to that kind of a reaction. I released the patient/customer into the care of her dad. You have my permission to contact patient directly about how she is doing now. I was not involved or have any knowledge of any follow-up care she may have recieved.


VAERS ID: 2724666 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Massachusetts  
Vaccinated: 2023-12-15
Onset: 2023-12-15
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 5 LA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Exposure during pregnancy, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal vitamins daily
Current Illness: Pregnancy nausea for 5 weeks, that had stopped one week before the vaccination
Preexisting Conditions:
Allergies: Cats and dogs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pregnancy - no complications, but nausea weeks 4.5-10.5, due date June 27; 3rd pregnancy (1 previous live birth) Adverse reactions: diarrhea 5 times starting one hour after and lasting 1 hour (then took Immodium), vomiting 2 times


VAERS ID: 2700934 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Massachusetts  
Vaccinated: 2023-10-22
Onset: 2023-10-22
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA YG4SK / N/A LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370673 / N/A RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Patient received flucelvax and spikevax (one in each arm)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received Spikevax in the left arm and flucelvax in the right arm. Right after the flu vaccine was administered, the patient quickly stood up and gestured that he could not breathe. Pharmacist grabbed and Epipen and delegated staff to call 911, just as she was about to administer the Epipen the patient coughed and seemed to be breathing sufficiently.


VAERS ID: 1999110 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Massachusetts  
Vaccinated: 2022-01-02
Onset: 2022-01-02
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033H21A / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308496 / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Head injury, Loss of consciousness, Seizure
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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: dizziness unknown which vaccine or dates
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: amoxil and penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was given vaccines reported that she was feeling light headed. about 10 minutes later passed out hitting her head on the floor. She than began to seize; emergency was called. patient had regained consciousness and was alert when ems arrived pt was transported to local hospital by ems


VAERS ID: 2705816 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Massachusetts  
Vaccinated: 2023-10-27
Onset: 2023-10-27
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HG2649 / 4 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370665 / 7+ LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site urticaria, Lymphadenopathy, Vaccination site erythema, Vaccination site warmth
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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions:
Allergies: None Known
Diagnostic Lab Data:
CDC Split Type:

Write-up: hives at injection site and swollen lymph nodes under left arm; hives resolved after benadryl; vaccine site was warm/red


VAERS ID: 2683583 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Massachusetts  
Vaccinated: 2023-09-15
Onset: 2023-09-01
Submitted: 0000-00-00
Entered: 2023-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HH7595 / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944445 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Balance disorder, Brain fog, Dizziness, Fatigue, Feeling abnormal, Headache, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad), Vestibular disorders (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: Astrazeneca COVID vaccine headaches and spacey.
Other Medications: Prazosin 1mg Ezetimibe 10mcg Venlafaxine 225mg Chlorthalidone 25mg Metoprolol Succ ER 25mg Levothyroxine 40mg Simvastatin 40mg Lisinopril 2.5mg
Current Illness: None
Preexisting Conditions: OCD, Hypoactive Thyroid, Depression. Obese
Allergies: Lexapro Impotence
Diagnostic Lab Data:
CDC Split Type:

Write-up: Head pain right hemisphere within two hours, very similar but less intense as to when I recovered for months from long covid. Muscle pains and aches however no fever, runny nose as well. Brain fog off and on along with overall tiredness. All similar to two time I had COVID and recovered from long covid. Also dizziness when getting up and slight loss of balance time to time. Spacey awareness.


VAERS ID: 2738307 (history)  
Form: Version 2.0  
Age: 0.67  
Sex: Female  
Location: Massachusetts  
Vaccinated: 2023-11-13
Onset: 2023-11-30
   Days after vaccination: 17
Submitted: 0000-00-00
Entered: 2024-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AU5551B / UNK - / -
DTPPVHBHPB: DTAP+IPV+HIB+HEPB (VAXELIS) / MSP VACCINE COMPANY U7623AA / UNK - / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. U8230BA / UNK - / -
PNC20: PNEUMO (PREVNAR20) / PFIZER/WYETH GY1933 / UNK - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1975783 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Immunisation reaction
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Encntr for routine child health exam w/o abnormal findings; Encounter for immunization
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Adverse effect of vaccines and biological substances, init on 2023-11-30.


VAERS ID: 2738308 (history)  
Form: Version 2.0  
Age: 1.08  
Sex: Female  
Location: Massachusetts  
Vaccinated: 2023-12-01
Onset: 2023-12-04
   Days after vaccination: 3
Submitted: 0000-00-00
Entered: 2024-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AU5551B / UNK - / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 4E25J / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. W029541 / UNK - / -
PNC20: PNEUMO (PREVNAR20) / PFIZER/WYETH GY1933 / UNK - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. X017490 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Immunisation reaction
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: TRIAMCINOLONE ACETONIDE 0.025 % EX OINT
Current Illness: Encntr for routine child health exam w/o abnormal findings; Encounter for immunization
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Adverse effect of vaccines and biological substances, init on 2023-12-04.


VAERS ID: 2738314 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Massachusetts  
Vaccinated: 2023-12-20
Onset: 2023-12-26
   Days after vaccination: 6
Submitted: 0000-00-00
Entered: 2024-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3030337 / UNK - / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 3GY4R / UNK - / -
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER 35S2S / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Immunisation reaction
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: LEVOTHYROXINE SODIUM 125 MCG PO TABS
Current Illness: Hypothyroidism, unspecified; Anxiety disorder, unspecified; Persons encountering health services in oth circumstances; Hypothyroidism, unspecified; Anxiety disorder, unspecified; Diarrhea, unspecified; Encntr screen for infections w sexl mode of transmiss; Encounter for screening for infec/parastc diseases, unsp; Encounter for screening for lipoid disorders; Encounter for immunization; Persons encountering health services in oth circumstances
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Adverse effect of vaccines and biological substances, init on 2023-12-26.


VAERS ID: 1903473 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Massachusetts  
Vaccinated: 2021-11-24
Onset: 2021-11-25
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2021-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 63547358 / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 6354984 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising, Injection site erythema, Injection site swelling, Pain in extremity
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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: COVID vacination Moderna caused severe arm pain, muscle and joint soreness, fatigue
Other Medications: Super B-complex and women''s multi-vitamin, vitamin C
Current Illness: None
Preexisting Conditions: none
Allergies: Shellfish (shrimp, crab, lobster)
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Bruising at injection site for influenza vaccine, redness and swelling on left arm near injection below injection site, arm soreness


VAERS ID: 2714991 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Massachusetts  
Vaccinated: 2023-11-02
Onset: 2023-11-02
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3031897 / 4 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. AU3128B / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Immediate post-injection reaction, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (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: Lysine; MVI; Sertraline
Current Illness:
Preexisting Conditions: depression; fatigue
Allergies: NKA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Immediate injection site pain which continued for 2 weeks now. Exam indicates subacromial bursitis of right shoulder (vaccination arm). Treatment- subacromial corticosteroid injection 11/16/2023 given and home exercise packet.


VAERS ID: 2603159 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Massachusetts  
Vaccinated: 2021-10-27
Onset: 2021-10-27
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308469 / UNK RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Apraxia, Head discomfort, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: suboxone, omeprazole, trazadone, citalopram, buspirone
Current Illness: HTN, GERD, RPE (retinal pigment epithelium) hypertrophy, generalized anxiety disorder, opioid dependency,
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data: Unknown.
CDC Split Type:

Write-up: Pt was at the pharmacy when she reported she can''t open her eyes and feels pressure to her head and left arm numbness. Pt reports had covid vaccine 20 minutes ago. Ambulance was called. Pt was given EpiPen at 11:58 am and was then brought to the walk in clinic to wait for ambulance. Ambulance arrived and pt taken to ED for evaluation.


VAERS ID: 2716868 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Massachusetts  
Vaccinated: 2023-11-21
Onset: 2023-11-21
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 374869 / N/A - / IM

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

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

Write-up: PATIENT CAME IN TO RECEIVE THEIR COVID VACCINE AND THE FLU VACCINE. TECHNICIAN VERIFIED WITH THE IMMUNIZATION SELECTION TOOL AND ENTERED INTO COMPUTER THE CORRECT VACCINATIONS. THE PHARMACIST ADMINISTERING THE VACCINES HAD GRABBED THE PEDIACTRIC DOSE OF THE COVID INSTEAD OF THE ADULT DOSE. ONE TECHNICIAN WAS SCANNING THE INFORMATION INTO THE SYSTEM WHEN WE NOTICED THE VACCINE STICKER WAS INCORRECT FOR THE PATIENT, WE IMMEDIATELY NOTIFIED THE PHARMACIST AND THEN HE PROCEEDED TO CALL THE PATIENT AND CDC.


VAERS ID: 2716203 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Massachusetts  
Vaccinated: 2023-11-21
Onset: 2023-11-21
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 8058876 / N/A RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944453 / N/A RA / IM

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

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

Write-up: Patient fainted twice after second vaccine administered. Patient''s Mom stated after the fact that the patient has fainted after vaccines in the past but did not disclose that information prior to because she thought her daughter had "grown out of it".


VAERS ID: 2744066 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Massachusetts  
Vaccinated: 2024-01-18
Onset: 2024-01-18
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2024-02-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 4 LA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 7+ LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Back pain, C-reactive protein increased, Chills, Computerised tomogram head abnormal, Computerised tomogram normal, Constipation, Diplegia, Diplopia, Dyskinesia, Dyspnoea, Gait disturbance, Heart rate increased, Hemiparesis, Hypoaesthesia, Hypoaesthesia oral, Imaging procedure, Magnetic resonance imaging normal, Microcephaly, Muscular weakness, Musculoskeletal disorder, Orthostatic hypertension, Pain, Paralysis, Peroneal nerve palsy, Pyrexia, Tachycardia, Tremor, Urinary retention, Walking aid user
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Congenital, familial and genetic disorders (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Dyskinesia (narrow), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Ocular motility disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 20 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Clonidine 0.1 mg, yasmin 0.03 mg, cymbalta 60 mg, straterra 40 mg, lithium ER 450 mg, Lamictal 200 mg, Hydroxyzine 50 mg, benadryl 50 mg, pepto
Current Illness: Covid-19- 3 weeks prior
Preexisting Conditions: Non-alcoholic fatty liver disease
Allergies: Bee venom
Diagnostic Lab Data: Have had a multitude of CT?s and MRIs. Everything came back normal besides my brain Ct. I was diagnosed with hypoplasia of the cranial sinuses. Not sure if that?s new or not. My C-reactive protein was 23 when I came in to the hospital.
CDC Split Type:

Write-up: symptoms: left arm numbness and left sided neck numbness at first. Led to left side body numbness and weakness. I had tachycardia and trouble breathing. My left hand was stuck in a clenched fist position. About 17 hours after shots, I developed a low grade fever and chills. My heart rate rapidly increased to 180 bpm, my whole body developed paralysis, I had double vision, and my lips went numb so I couldn?t open my mouth and couldn?t breathe. This developed into waist down paralysis, bladder retention, and constipation that lasted 11 days. The paralysis in legs turned into weakness that would get worse the more I attempted to walk. When I stood up, I experienced my heart rate going up to 180 bpm and blood pressure would go up to around 150/100. I developed numbness frequently in my left foot and toes. My left lower back hurts and knee hurts while I walk. I developed left foot drop. When I rest completely in bed, my legs get less weak. Once, I try to walk a bit, my legs decline in strength. I?m currently in the hospital and have been here for 2 1/2 weeks since the day I got the shots. I have had a ton of imaging and labs done. Currently my legs are declining again. When I try to walk with the walker, I can?t make steps, my feet drag, and I shake a lot. It did get better once I was in bed rest for 2 days. Currently awaiting an acute rehab bed for physical therapy. We have not tried any treatments.


VAERS ID: 2587240 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Massachusetts  
Vaccinated: 2022-11-10
Onset: 2022-11-12
   Days after vaccination: 2
Submitted: 0000-00-00
Entered: 2023-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH GL0446 / 4 LA / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 942395 / UNK LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Neuropathy peripheral, Sensory loss
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre 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: ADDERALL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: ADHD; Carpal tunnel release
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202300078039

Write-up: Neuropathy in fingertips of both hands, did not pass first knuckle. Started two days after vaccination, lasted about two weeks. Occasionally happens in middle and ring fingers. Consistent loss of sens; Neuropathy in fingertips of both hands, did not pass first knuckle. Started two days after vaccination, lasted about two weeks. Occasionally happens in middle and ring fingers. Consistent loss of sens; This is a spontaneous report received from a contactable reporter(s) (Consumer or other non HCP). The reporter is the patient. A 53-year-old female patient (not pregnant) received BNT162b2, BNT162b2 omi ba.4-5 (BNT162B2, BNT162B2 OMI BA.4-5), on 10Nov2022 at 17:30 as dose 4 (booster), single (Lot number: GL0446) at the age of 53 years, in left arm for covid-19 immunisation; influenza vaccine inact sag 4v (FLUCELVAX QUAD), on 10Nov2022 as dose number unknown, single (Lot number: 942395), in left arm for immunisation. The patient''s relevant medical history included: "ADHD" (unspecified if ongoing); "Prior carpal tunnel release in both hands." (unspecified if ongoing). The patient had no allergy. Concomitant medication(s) included: ADDERALL. Vaccination history included: Covid-19 vaccine (DOSE 1, SINGLE, Manufacturer unknown), for COVID-19 immunization; Covid-19 vaccine (DOSE 2, SINGLE, Manufacturer unknown), for COVID-19 immunization; Covid-19 vaccine (DOSE 3 (BOOSTER), SINGLE, Manufacturer unknown), for COVID-19 immunization. The patient had no covid prior vaccination. The patient didn''t have covid tested post vaccination. The following information was reported: NEUROPATHY PERIPHERAL (medically significant), SENSORY LOSS (non-serious) all with onset 12Nov2022, outcome "recovered with sequelae" and all described as "Neuropathy in fingertips of both hands, did not pass first knuckle. Started two days after vaccination, lasted about two weeks. Occasionally happens in middle and ring fingers. Consistent loss of sens". Therapeutic measures were not taken as a result of neuropathy peripheral, sensory loss. The information on the batch/lot number for BNT162B2, BNT162B2 OMI BA.4-5 has been requested and will be submitted if and when received.


VAERS ID: 2690329 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Maryland  
Vaccinated: 2023-09-30
Onset: 2023-09-30
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 4 AR / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling cold, Hyperhidrosis, Immediate post-injection reaction, Oropharyngeal discomfort, Presyncope, Tinnitus, Visual impairment
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: I think it was the 2nd Covid shot at age 12. She had an extremely mild rash on her arms shortly after the injection. It resolved
Other Medications: none
Current Illness: none. Two migraines in the month prior to the vaccine.
Preexisting Conditions:
Allergies: none known
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Immediate onset of dizziness (she felt like she almost fainted), forehead was sweaty and body felt cold, difficult to see (bright), ringing in the ears, throat felt "funny" (although she was able to breath normally and drink water). This was her second Covid booster after the initial set of two shots (she had received her last booster in Oct 2022).


VAERS ID: 2689125 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Maryland  
Vaccinated: 2023-09-28
Onset: 2023-09-28
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Chills, Decreased appetite, Dysphonia, Dyspnoea, Gait disturbance, Headache, Mobility decreased, Pain in extremity, Peripheral swelling, Pruritus, Sleep disorder
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: These symptoms seem different from the previous COVID reactions. My COVID injections: 03/22/21 at pharmacy Pfizer ER8732 exper
Other Medications: Simbrinza, Synthyroid .075, Amlodopine .010, clobetasol
Current Illness:
Preexisting Conditions:
Allergies: sulfur
Diagnostic Lab Data:
CDC Split Type:

Write-up: I received COVID and Flu injections around 10:40 am on 9/28/23. Ran errands. Arrived home at 1:30 pm. Went downstairs started laundry coming (2:00)upstairs was short of breathe, held rail to climb stairs. Around 3:30 pm went downstairs to move laundry once again short of breathe coming back up. No appetite had soup at 6:00 pm. Took tylenol for arm pain. At 8:00 pm began to have burning pain on each side back upper spine area. At 10:00 pm went to bed was awaken at 2:00 am on 9/29/23 with burning pain from top of neck to middle back. Could not lay on back or left side. Attempted to sit-up and sleep. Friday morning struggle to get out of bed. Both feet hurt to walk and wobbled to bathroom. Right sore tonsil, voce was whisper. Wobbled to get around ALL day. Hurt to move arround or walk on Friday Feet were never painful before. Hand and fingers hurt/painful. Right Arm very sore and swollen.Rested and took Tylenol. Around 6 pm had a low grade fever of 99.1. Temp at 9 pm 99.1.. At 11 pm went to urinate would have chills for 30 minutes return ing to bed. this happened at 1 am, 3 am and 5 am on 9/30/23. Had slight headache pain in right side of head on Friday. Friday night had same on left side. Right arm now has soreness and itching.


VAERS ID: 1831945 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Maryland  
Vaccinated: 2021-10-29
Onset: 2021-10-29
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032F21A / 2 LA / SC
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 RA / SC

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Incorrect route of product administration, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Drug abuse and dependence (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Both shots were given in the wrong place (subcutaneously). They were given on the back of the arm, into fat/tissue. The shot on the left arm has caused sustained redness and pain.


VAERS ID: 1833078 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Maryland  
Vaccinated: 2021-10-26
Onset: 2021-10-31
   Days after vaccination: 5
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 312869 / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Tinnitus
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: bisoprolol 10 mg, Breo Ellipta (fluticasone furoate 250 mcg/vilanterol 25 mcg), senior multivitamin, magnesium oxide 400 mg, B12 1000 mcg
Current Illness: None
Preexisting Conditions: asthma, hypertension
Allergies: Sulfonamides, NSAIDs, nitrofurans, azithromycin, verapamil
Diagnostic Lab Data:
CDC Split Type:

Write-up: tinnitus worsening from evening of 10/31/21 (both ears worse in left ear)


VAERS ID: 2687675 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Maryland  
Vaccinated: 2023-09-27
Onset: 2023-09-27
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HD9835 / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370664 / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Dizziness, Vision blurred, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: na
Diagnostic Lab Data: na
CDC Split Type:

Write-up: 5-10 min after vaccination patient came back complain of COB, lightheadness , blurred vision monitor with team. pulls was ok patient did not need EpiPen inject. patient was send to ER after EMT arrival, also before EMT arrival she vomited


VAERS ID: 2525635 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Maryland  
Vaccinated: 2021-11-06
Onset: 2021-11-06
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034F21A / 2 LA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, 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? 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: Received covid shot Moderna and flu shot (unknown brand) in same arm at the same time. Ever since has had constant dull pain in left shoulder and arm. Also gets sharp pain in left shoulder shooting down entire arm when reaching out or up. They should not have given both shots in the same arm at the same time. This is his spouse filling this form out. He should go to the doctor but has not gone as of yet.


VAERS ID: 2043579 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Michigan  
Vaccinated: 2022-01-17
Onset: 2022-01-17
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308491 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperhidrosis, Hypotension, Lethargy, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Pt received pfizer vaccine first, followed by flucelvax. Pt fainted after flucelvax (10sec post flucelvax, <2min post pfizer covid vaccine). Pt was diaphoretic, hypotensive to 67/49 at nadir, several bouts of emesis, and was lethargic. Pt denied SOB, potential swelling of lower lip, but unable to determine change from baseline. EMS contacted, no medical intervention made.


VAERS ID: 1894731 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Michigan  
Vaccinated: 2021-10-29
Onset: 2021-11-13
   Days after vaccination: 15
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Lower respiratory tract infection, Nasal congestion, Oropharyngeal pain, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Infective pneumonia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: COVID-19 test
CDC Split Type: vsafe

Write-up: It started with a sore throat, a cough, nasal congestion, and chest congestion. I took a COVID-19 test on November 18th, and the result was negative. I then had a virtual visit on November 20th. They thought it might be an upper respiratory infection and prescribed me antibiotics.


VAERS ID: 2007027 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Michigan  
Vaccinated: 2021-12-14
Onset: 2021-12-14
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308492 / 1 RA / IM

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

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

Write-up: THE PATIENT WENT TO ANOTHER PHARMACY TO RECEIVE THEIR SECOND DOSE AND THE PHARMACIST REALIZED THAT THEIR VACCINE CARD FOR THE INITIAL DOSE SHOWED THEY RECEIVED MODERNA, WHICH IS NOT APPROVED FOR HER AGE. THE PATIENT DID NOT HAVE ANY ADVERSE REACTIONS TO THE MODERNA VACCINE. THE PATIENT''S FATHER CAME TO THE PHARMACY TO REPORT THE ERROR. THE VACCINE THAT WAS ENTERED INTO THE SYSTEM FOR HER INITIAL DOSE WAS FOR THE COVID PFIZER 12+. THIS LOCATION DOES NOT DO PFIZER 12+ VACCINES AND THE VAR AND VACCINATION CARD SHOW THAT SHE ACTUALLY RECEIVED MODERNA FOR HER FIRST DOSE.


VAERS ID: 2693272 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Michigan  
Vaccinated: 2023-09-29
Onset: 2023-10-04
   Days after vaccination: 5
Submitted: 0000-00-00
Entered: 2023-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3030368 / 5 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944458 / N/A RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Herpes zoster, Neuralgia, Rash
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (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: Sertraline HCl 100 mg once daily Ferrous sulfate 65 mg iron equivalent once daily Claritin (generic) otc once daily Generic multivitamin once daily
Current Illness: None
Preexisting Conditions: Depression Iron deficiency
Allergies: None
Diagnostic Lab Data: NA. Confirmed visually by medical personnel
CDC Split Type:

Write-up: Shingles development on back below left shoulder blade. Uncomplicated, no treatment other than calamine lotion. Rash rapidly resolving within 1 week of appearance. Minimal to no nerve pain.


VAERS ID: 2727606 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Michigan  
Vaccinated: 2023-12-01
Onset: 2023-12-27
   Days after vaccination: 26
Submitted: 0000-00-00
Entered: 2023-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER 3032218 / 1 UN / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370649 / UNK UN / IM

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: Hydroxyzine, melatonin
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Administered a 2nd time on 12/27


VAERS ID: 2404271 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Michigan  
Vaccinated: 2021-11-11
Onset: 2022-07-30
   Days after vaccination: 261
Submitted: 0000-00-00
Entered: 2022-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034F21A / 3 - / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 312850 / N/A - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Asthenia, COVID-19, Decreased appetite, Dehydration, Renal mass
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Guillain-Barre syndrome (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (narrow), Opportunistic infections (broad), COVID-19 (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? Yes, 2 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 MG tablet amLODIPine (NORVASC) 5 MG tablet amLODIPine (NORVASC) 5 MG tablet ascorbic acid (VITAMIN C) 500 MG tablet chlorthalidone (HYGROTON) 25 MG tablet cholecalciferol (VITAMIN D3) 25 MCG (1000 UT) tablet
Current Illness: 10/21/2021- Pressure Injury of Right heel, Stage 3
Preexisting Conditions: Lung nodules Goiter Benign prostatic hyperplasia Hypercholesterolemia Colon polyp Diabetic nephropathy GERD (gastroesophageal reflux disease) HTN (hypertension), benign Barrett''s esophagus Diverticulosis Tobacco abuse, in remission Anemia of chronic disease Chronic Left Leg edema S/P total knee arthroplasty Atherosclerosis of abdominal aorta History of diabetic ulcer of foot Statin intolerance - Drug-induced bradycardia (betablocker) Atrial fibrillation, Drug-induced coagulation inhibitor disorder Status post partial amputation of foot, right Stage 3b chronic kidney disease Knee swelling Knee pain Hemarthrosis of right knee Type 2 diabetes mellitus with right diabetic foot ulcer Pressure injury of right heel, stage 3 Venous stasis of both lower extremities Type 2 diabetes mellitus- Diet Controlled (history of insulin use) Weakness COVID-19 Acute renal failure superimposed on chronic kidney disease Statin started by Vascular Surgery with Rx to be taken over by patient''s PCP
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Discharge Provider: Primary Care Provider: Admission Date: 7/30/2022 Discharge Date: Aug 1, 2022 PRESENTING PROBLEM: COVID-19 [U07.1] HOSPITAL COURSE: Patient is a 79-year-old male with past medical history of hypertension, CKD 3, atrial fibrillation with a new diagnosis of renal mass who presented the hospital with acute COVID-19 infection. Patient was weak and dehydrated. Patient had acute on chronic renal failure and was started on IV fluids. Patient did not meet any criteria for treatment of his COVID-19 infection as he was not hypoxic. Patient improved on IV fluids, his renal function improved, his energy level improved, and his appetite improved. Patient was able tolerate general diet on the day of discharge. Patient renal function was significantly improving. Patient''s ACE inhibitor was held given his acute on chronic renal failure and this was discontinued at the time of discharge. Patient worked with physical therapy and occupational therapy who recommended home health care. Patient was then discharged home in stable condition to follow-up with primary care physician as well as his urologist for his newly diagnosed renal mass.


VAERS ID: 1913269 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Michigan  
Vaccinated: 2021-11-02
Onset: 2021-11-02
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051F21A / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308443 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Joint range of motion decreased, Muscular weakness, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (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: citalopram
Current Illness: none
Preexisting Conditions: depression
Allergies: none
Diagnostic Lab Data: nono
CDC Split Type:

Write-up: unable to make a fist with both hands for 3 days and muscle aches in legs that still persist and fatigue


VAERS ID: 2688190 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Michigan  
Vaccinated: 2023-09-19
Onset: 2023-09-01
Submitted: 0000-00-00
Entered: 2023-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HF9275 / 1 LA / OT
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944457 / 1 RA / -

Administered by: Other       Purchased by: ?
Symptoms: Cough, Epistaxis, Fatigue, Pain
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19 (Treatment of COVID-19 with Paxlovid from 21Jun2022 to 26Jun2022.); Sulfonamide allergy (Sulfa based medication - Steven-Johnsons Syndrome as a result of allergy)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202300307012

Write-up: body aches; fatigue; slight cough; bloody nose; This is a spontaneous report received from a contactable reporter(s) (Consumer or other non HCP). The reporter is the patient. A 29-year-old female patient (not pregnant) received bnt162b2 omi xbb.1.5 (COMIRNATY (2023-2024 FORMULA)), on 19Sep2023 at 07:15 as dose 1, single (Lot number: HF9275) at the age of 29 years intramuscular, in left arm for covid-19 immunisation; influenza vaccine inact sag 4v (FLUCELVAX QUAD), on 19Sep2023 as dose 1, single (Lot number: 944457), in right arm for influenza immunisation. The patient''s relevant medical history included: "Sulfa" (unspecified if ongoing), notes: Sulfa based medication - Steven-Johnsons Syndrome as a result of allergy; "COVID-19", start date: 2022, stop date: 2022, notes: Treatment of COVID-19 with Paxlovid from 21Jun2022 to 26Jun2022. There were no concomitant medications. Vaccination history included: Covid-19 vaccine (DOSE 1; MANUFACTURER UNKNOWN), for COVID-19 immunisation; Covid-19 vaccine (DOSE 2; MANUFACTURER UNKNOWN), for COVID-19 immunisation; Covid-19 vaccine (DOSE 3 (BOOSTER); MANUFACTURER UNKNOWN), for COVID-19 immunisation; Covid-19 vaccine (DOSE 4 (BOOSTER); MANUFACTURER UNKNOWN), for COVID-19 immunisation. The following information was reported: EPISTAXIS (non-serious) with onset Sep2023, 30 hrs after the suspect product(s) administration, outcome "recovered" (Sep2023), described as "bloody nose"; PAIN (non-serious) with onset 19Sep2023 at 21:00, outcome "recovered" (Sep2023), described as "body aches"; FATIGUE (non-serious) with onset 19Sep2023 at 21:00, outcome "recovered" (Sep2023); COUGH (non-serious) with onset 19Sep2023 at 21:00, outcome "recovered" (Sep2023), described as "slight cough". Therapeutic measures were not taken as a result of pain, fatigue, cough, epistaxis. Additional information: Approximately 14 hours after receiving both the Flu and Covid Vaccines, patient experienced body aches and fatigue and a slight cough that lasted roughly 24 hours. Then 30 hours after vaccination, patient experienced a bloody nose. No treatment was received. The patient did not COVID tested post vaccination.


VAERS ID: 1829438 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Michigan  
Vaccinated: 2021-10-26
Onset: 2021-10-26
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308523 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, 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: unknown
Current Illness: unknown
Preexisting Conditions:
Allergies: nkda
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient received 0.5mL for Moderna booster - should have been 0.25mL.


VAERS ID: 2719562 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Michigan  
Vaccinated: 2023-11-29
Onset: 2023-11-29
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HF9300 / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 374407 / 1 LA / IM

Administered by: Private       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: amitriptyline
Current Illness: none
Preexisting Conditions: anxiety, functional abdominal pain
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient already received a Flu vaccine this season. Patient received Flucelvax Quad lot #370659 in left arm, IM injection on 9/27/23. Patient has had no symptoms.


VAERS ID: 2287049 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Michigan  
Vaccinated: 2021-12-09
Onset: 2022-05-13
   Days after vaccination: 155
Submitted: 0000-00-00
Entered: 2022-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H21A / 3 - / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308441 / N/A - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Biopsy bone normal, Brain natriuretic peptide increased, C-reactive protein increased, COVID-19, Condition aggravated, Culture positive, Osteomyelitis, Staphylococcus test positive, Surgery, Toe amputation, Wound treatment
SMQs:, Cardiac failure (broad), Pulmonary hypertension (broad), Osteonecrosis (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (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? Yes, 6 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 MG tablet albuterol (PROVENTIL) (2.5 MG/3ML) 0.083% nebulization albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler allopurinol (ZYLOPRIM) 100 MG tablet ascorbic acid (VITAM
Current Illness: None
Preexisting Conditions: CAD (coronary artery disease) Ischemic cardiomyopathy OSA (obstructive sleep apnea) Hyperlipidemia associated with type 2 diabetes mellitus (HCC) Hypertension associated with diabetes (HCC) Type 2 diabetes mellitus with diabetic nephropathy (HCC) Atherosclerosis of native artery of both lower extremities with intermittent claudication (HCC) Chronic diastolic congestive heart failure (HCC) Low back pain Class 3 severe obesity due to excess calories with serious comorbidity and body mass index (BMI) of 45.0 to 49.9 in adult (HCC) COPD (chronic obstructive pulmonary disease) (HCC) Peripheral arterial disease (HCC) Diabetic polyneuropathy associated with type 2 diabetes mellitus (HCC) Charcot''s joint arthropathy in type 2 diabetes mellitus (HCC) Recurrent major depressive disorder, in full remission (HCC) Primary osteoarthritis involving multiple joints Diabetic ulcer of left midfoot associated with type 2 diabetes mellitus, with necrosis of muscle (HCC) Stasis edema with ulcer, bilateral (HCC) Stage 3b chronic kidney disease (HCC) Chronic gout without tophus, unspecified cause, unspecified site Osteomyelitis (HCC) COVID-19
Allergies: CodeineHives PenicillinsHives PrednisoneRash TetracyclinesRash MetforminDiarrhea
Diagnostic Lab Data:
CDC Split Type:

Write-up: Discharge Provider: MD Primary Care Provider at Discharge: DO Admission Date: 5/13/2022 Discharge Date: 5/19/2022 PRESENTING PROBLEM: Elevated C-reactive protein (CRP) Elevated brain natriuretic peptide (BNP) level History of MRSA infection Other acute osteomyelitis of left foot (HCC) Stage 3b chronic kidney disease (HCC) COVID-19 Osteomyelitis (HCC) HOSPITAL COURSE: 74-year-old with osteomyelitis of left 5th metatarsal head admitted for IV antibiotics and Podiatry consultation and resulting surgery. Patient also with COVID. Has remained on room air during his entire stay. Patient with osteomyelitis on presentation. Patient underwent partial-amputation of left 5th ray on May 15th:. Patient was maintained on IV vancomycin because of previous culture showing MRSA infection. Repeat cultures did grow out Staph aureus. Bone biopsies done during her surgery did not show any evidence osteomyelitis within the 5th metatarsal. Infectious Disease was consulted they recommended using doxycycline for a total of 14 days of treatment. Patient completed 4 days of treatment or hospitalization. Patient will be discharged on 10 days of doxycycline. Overall patient is doing well. He received a dressing change this morning. Patient will have home health care for further dressing changes per Podiatry recommendations. Patient has been given a dose of doxycycline during hospitalization because of a previous questionable allergy to tetracycline. If tolerates, will discharge home antibiotics as outlined above.


VAERS ID: 2519999 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Michigan  
Vaccinated: 2022-11-28
Onset: 2022-11-28
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054B22A / 2 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 348369 / UNK RA / IM

Administered by: Unknown       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? 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: Moderna vaccine administered 11/28/2022 beyond published expiration date of 11/25/22. No adverse events reported.


VAERS ID: 2621585 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Michigan  
Vaccinated: 2021-12-09
Onset: 2023-03-29
   Days after vaccination: 475
Submitted: 0000-00-00
Entered: 2023-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8762 / 3 - / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308476 / N/A - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Anaemia, Angiopathy, Anticoagulant therapy, Biopsy colon, Blood sodium decreased, COVID-19, Chest X-ray abnormal, Colonoscopy abnormal, Dehydration, Dizziness, Dyspnoea, Endoscopy upper gastrointestinal tract normal, Faeces discoloured, Haematochezia, Haemoglobin decreased, Hypertension, Hyponatraemia, Iron deficiency, Large intestine polyp, N-terminal prohormone brain natriuretic peptide increased, Orthostatic hypotension, SARS-CoV-2 test positive, Syncope, Troponin, Ventricular tachycardia
SMQs:, Torsade de pointes/QT prolongation (narrow), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (broad), Anaphylactic reaction (broad), Haematopoietic erythropenia (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Gastrointestinal premalignant disorders (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific inflammation (broad), Hyponatraemia/SIADH (narrow), Ischaemic colitis (broad), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Noninfectious diarrhoea (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (narrow), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow), Noninfectious myocarditis/pericarditis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler apixaban (ELIQUIS) 5 MG tablet budesonide/formoterol (SYMBICORT) 80-4.5 MCG/ACT inhaler ferrous gluconate (FERGON) 324 (38 Fe) MG tablet furosemide (LASIX
Current Illness: None
Preexisting Conditions: Hypertensive heart disease Bilateral carotid bruits Status post catheter cryoablation of atrial fibrillation, 05/19/17 Hypercholesterolemia Hypoalphalipoproteinemia Sick sinus syndrome Nonocclusive coronary artery disease Chronic fatigue Atherosclerosis of native artery of both lower extremities with intermittent claudication Lichen simplex chronicus Tobacco use disorder Acute on chronic combined systolic and diastolic heart failure Hypoplastic aortic arch Left ventricular noncompaction cardiomyopathy PAD (peripheral artery disease) Benign essential HTN Hyperkalemia Hyponatremia Orthostatic hypotension Persistent atrial fibrillation Claudication Hypertensive disorder Status post right femoral-popliteal bypass with polytetrafluoroethylene graft, 10/12/2017 Status post dual chamber ICD implantation, 07/10/2020 Atypical atrial flutter Severe left ventricular systolic dysfunction (EF 0.32) Long term current use of antiarrhythmic drug Iron deficiency anemia Syncope and collapse
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Discharge Provider: MD Primary Care Provider at Discharge: MD Admission Date: 3/29/2023 Discharge Date: 4/4/2023 PRESENTING PROBLEM: Syncope and collapse [R55] Syncope, unspecified syncope type [R55] Anemia, unspecified type [D64.9] HOSPITAL COURSE: ? 58 y.o. male with past medical history significant for cardiomyopathy, chronic combined CHF with recovered EF, AFib/flutter s/p cryoablation on eliquis (2017), sick sinus syndrome s/p dual chamber AICD (2020), coronary artery disease s/p CABG (2020), hypertension, hyperlipidemia, PAD s/p BLE bypass, history of orthostatic hypotension, chronic neck pain on opioids and history of tobacco use disorder ($g 100 pack years) who presented to the ED due to dyspnea and syncopal events. ? In the ED, his hgb was 8.1 which is down from 11 in 11/2022. He noticed intermittent episodes of formed, black stool as well as intermittent darker red blood in stool that turns toilet bowel rust colored. He was admitted to facility 7/2022 with episode of syncope in setting of BRBPR, dehydration, AKI, hyponatremia and orthostatic hypotension. His hgb remained stable in 10-11 range, so he was discharged with plan for outpatient EGD / Colonoscopy which he never completed. In ED he was mildly hypertensive, temp 37.8?, heart rate 70s-80s, respirations 18 and O2 98% on room air. Labs notable for sodium 128, hemoglobin 8.1, NT proBNP 7808, troponin 28 with a repeat of 29. Chest x-ray shows mild central vascular congestion without confluent infiltrates or effusions. Patient admitted to medical floor, tested positive for COVID-19 noted to be on 2 L of oxygen, started on dexamethasone and remdesivir. During the hospital course patient was noted to have nonsustained V-tach for which Cardiology was consulted and recommended conservative management optimization of medications and electrolytes. Patient was started on metoprolol. He finished a five day course of remedesivir and was weaned to RA. EGD done on 4/2 showed no acute findings, colonoscopy done on 4/2 showed multiple large colon polyps. Biospy results pending. GI recommends repeat colonoscopy in 3-6 months. GI will follow bxs. Eliquis was resumed. Patient was found to be iron deficient and given IV iron and started on oral supplements. He finished a five day course of doxycycline. Dizziness resolved prior to discharge. Patient was medically stable when discharged.


VAERS ID: 1836608 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Michigan  
Vaccinated: 2021-10-30
Onset: 2021-11-01
   Days after vaccination: 2
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Polio Vaccine 30+ years ago (Polio symptoms for a month) Mumps Vaccine (contracted Mumps)
Other Medications: Multi-Vitamins, EstroGel
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Mold
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt. states that after receiving the 3rd Booster of Phizer 10/30/2021, started experiencing symptoms 11/01/2021 of swelling in the Left eye, and mild swelling in the right eye. Primary visit *Telehealth communications recommendation for Follow-Up with Emergency Room visit 11/01/2021 *treating with Steroids & Antihistamines. Pt. still experiencing symptoms.


VAERS ID: 2628387 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Michigan  
Vaccinated: 2021-11-12
Onset: 2023-04-17
   Days after vaccination: 521
Submitted: 0000-00-00
Entered: 2023-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 - / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308485 / N/A - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Hypoxia, Laboratory test normal, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (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? Yes, 4 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 325 MG tablet acetaminophen (TYLENOL) 500 mg tablet albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler aluminum-magnesium hydroxide 200-200 MG/5ML suspension amlodipine-benazepril
Current Illness: None
Preexisting Conditions: HTN (hypertension) Hypercholesteremia DM (diabetes mellitus) (HCC) BPH (benign prostatic hypertrophy) Tobacco abuse, in remission Diverticulosis of colon Decreased dorsalis ped pulses - with nl ABI OSA on CPAP Diverticulosis Hypertension, essential COPD (chronic obstructive pulmonary disease) (HCC) Hypothyroidism (acquired) Fatty liver found on US - with mild elevated liver enzymes Normocytic normochromic anemia (~13) - mild with neg lab uw History of vertebral compression fracture Osteoporosis Iron deficiency anemia - wu in progress - Nondisplaced fracture of greater trochanter of right femur, initial encounter for closed fracture (HCC) GERD (gastroesophageal reflux disease) Dementia (HCC) Depression Closed fracture of multiple pubic rami, left, sequela COVID
Allergies: Darvocet [Propoxyphene N-apap]
Diagnostic Lab Data:
CDC Split Type:

Write-up: Discharge Provider: Primary Care Provider: PA-C Admission Date: 4/17/2023 Discharge Date: Apr 21, 2023 PRESENTING PROBLEM: Hypoxia [R09.02] COVID [U07.1] COVID-19 [U07.1] HOSPITAL COURSE: Patient is a 84 y.o. male with a past medical history of dementia, chronic obstructive pulmonary disease, hypertension, hyperlipidemia, BPH, type 2 diabetes, OSA on CPAP, hypothyroidism, chronic anemia, GERD who presented with shortness of breath from his assisted living facility. COVID 19 positive on admission requiring 2L NC. Remainder of work up relatively unremarkable. Started on dexamethasone and remdesivir. He was weaned quickly to room air. He completed 5 day course of remdesivir while in hospital and discontinued dexamethasone at discharge. Pulmonary have evaluated patient prior to discharge and he was able to ambulate on room air without significant symptoms. He did not qualify for home oxygen. In stable condition patient is discharged to facility with home health care.


VAERS ID: 2233852 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Michigan  
Vaccinated: 2021-12-18
Onset: 2021-12-18
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / UNK AR / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 309622 / UNK AR / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Blood fibrinogen increased, C-reactive protein increased, COVID-19, Cardiogenic shock, Chest pain, Conjunctival hyperaemia, Diarrhoea, Fibrin D dimer increased, Immunoglobulin therapy, Inflammatory marker increased, Intensive care, Multi-organ disorder, Multisystem inflammatory syndrome in children, N-terminal prohormone brain natriuretic peptide increased, Pyrexia, SARS-CoV-2 antibody test positive, SARS-CoV-2 test positive, Serum ferritin increased, Troponin increased, Vomiting
SMQs:, Cardiac failure (narrow), Acute pancreatitis (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Toxic-septic shock conditions (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Conjunctival disorders (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow), COVID-19 (narrow), Noninfectious myocarditis/pericarditis (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? Yes, ? days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: MIS-C onset same day as vaccination
Preexisting Conditions: N/A
Allergies: Unknown
Diagnostic Lab Data: COVID-19 Ab Nucleocapsid and Spike positive (12/21/21), COVID-19 PCR positive (12/21/21), elevated inflammatory markers (12/21/21-12/24/21) - see continuation Additional information for Item 19: From Question 19: Fibrinogen - 602 mg/dL, CRP - 121 mg/L, Ferritin - 304 mcg/L, Troponin - 64 ng/L, NT-proBNP - 3135 ng/L, D-dimer - 1040 ng/mL Fibrinogen - 602 mg/dL, CRP - 121 mg/L, Ferritin - 304 mcg/L, Troponin - 64 ng/L, NT-proBNP - 3135 ng/L, D-dimer - 1040 ng/mL
CDC Split Type:

Write-up: Case-patient had first Pfizer COVID-19 vaccine on 12/18/2021 and illness onset for MIS-C was on the same day. Case had COVID-19 with mild symptoms approximately 4 weeks before MIS-C onset. Case-patient met case definition for MIS-C with evidence of clinically severe illness requiring hospitalization, fever, multisystem organ involvement (cardiac, hematologic, & GI). The case-patient experienced cardiac shock, chest pain, abdominal pain, vomiting, diarrhea, conjunctival injection, and various elevated inflammatory markers (see box 19 below). Case-patient was treated with IVIG, ASA, steroids, and epinephrine and survived after a 4 day hospitalization (1 day in PICU).


VAERS ID: 2716182 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Michigan  
Vaccinated: 2023-11-16
Onset: 2023-11-16
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Fatigue, Oropharyngeal pain, Productive cough
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Infective pneumonia (broad)

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

Write-up: patient experienced sore throat, fatigue, cough, phlegm. those symptoms persisted for 5 days when the patient called us. I advised the patient to seek medical attention from his primary care provider.


VAERS ID: 2396545 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Michigan  
Vaccinated: 2021-12-29
Onset: 2022-07-22
   Days after vaccination: 205
Submitted: 0000-00-00
Entered: 2022-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3197 / 3 - / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308495 / N/A - / -
HEPAB: HEP A + HEP B (TWINRIX) / GLAXOSMITHKLINE BIOLOGICALS DK23D / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram pulmonary normal, COVID-19, Dyspnoea, Dyspnoea exertional, Gastrectomy, Hypoxia, Laparoscopic surgery, Malaise, SARS-CoV-2 test positive, Ultrasound Doppler normal
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (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? Yes, 1 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin 81 MG tablet benzonatate (TESSALON) 100 MG capsule fluticasone (FLONASE) 50 MCG/ACT nasal spray levalbuterol (XOPENEX HFA) 45 MCG/ACT inhaler loratadine (CLARITIN) 10 MG tablet montelukast (SINGULAIR) 10 MG tablet omeprazole (
Current Illness: None
Preexisting Conditions: L-TGA, levo-transposition of great arteries with ventricular inversion S/P Fontan procedure DILV (double inlet left ventricle) Splenomegaly Status post endometrial ablation Morbid obesity Congenital heart disease Itchy skin Knee stiffness, unspecified laterality Elevated serum protein level Dehydration Increased anion gap metabolic acidosis Hypoglycemia after GI (gastrointestinal) surgery DOE (dyspnea on exertion) COVID-19 virus infection
Allergies: Keflex [Cephalexin]Hives Reglan [Metoclopramide]Anxiety Contrast Dye [Ivp Dye, Iodine Containing]Other Medrol [Methylprednisolone]Rash, Joint Pain
Diagnostic Lab Data:
CDC Split Type:

Write-up: Discharge Provider: MD Primary Care Provider: MD Admission Date: 7/22/2022 Discharge Date: Jul 23, 2022 PRESENTING PROBLEM: Shortness of breath DOE (dyspnea on exertion) Hypoxia COVID-19 HOSPITAL COURSE: 32 year old female presented with history of transposition of the great vessels status post fontan procedure as an infant who underwent a laparoscopic gastric sleeve procedure on 5th July. She started having symptoms of covid on Tuesday followed by positive covid test. She was admitted to hospital on Saturday. She had CT angio done which was negative for PE though left pulmonary artery was non diagnostic. She is US venous duplex which was negative. She was evaluated by congenital heart. It was felt her symptoms were unlikely from PE. Her symptoms are felt from covid. She was not hypoxic even with exertion. She was discharged home with close follow up with PCP and congenital heart.


VAERS ID: 2718420 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Michigan  
Vaccinated: 2023-10-26
Onset: 2023-10-27
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3032233 / N/A LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944478 / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site reaction, Oral discomfort, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Welts below injection site and burning sensation in the mouth


VAERS ID: 2685616 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Michigan  
Vaccinated: 2023-09-24
Onset: 2023-09-24
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HG4659 / N/A RA / SC
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944464 / N/A LA / IM

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: unknown
Current Illness: none
Preexisting Conditions: none
Allergies: none noted
Diagnostic Lab Data:
CDC Split Type:

Write-up: he passed out after receiving the flu shot


VAERS ID: 2718652 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Michigan  
Vaccinated: 2023-11-28
Onset: 2023-11-28
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 206E23A / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944493 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, Posture abnormal
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), Dystonia (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: unknown
Preexisting Conditions: none reported on VAR
Allergies: None reported on VAR
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient received flu shot first and then after the second shot MODERNA Spikevax 12+ the patient passed out for 3 to 5 seconds. Patient slouched in seat and then recovered. Patient left with their mother. Per VAR filled out by mother they answered no to "have you ever had a reaction after receiving a vaccination, including fainting, or feeling dizzy?" but in the vaccination room the mother told the immunizing technician that the patient may get dizzy.


VAERS ID: 2707953 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Michigan  
Vaccinated: 2023-10-20
Onset: 2023-10-20
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 210F23-2A / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944493 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose, Blood pressure increased, Dizziness, Fall, Head injury, 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), Accidents and injuries (narrow), Hypertension (narrow), Cardiomyopathy (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: We did not ask the patient.
Current Illness: None on form , none reported to EMS.
Preexisting Conditions: None on form , none reported to EMS.
Allergies: None on form but told EMS allergy to Ceclor.
Diagnostic Lab Data: EMS checked blood pressure and heart rate while the patient was seated and standing. Blood sugar was checked and EMS manually felt the patient''s head for swelling.
CDC Split Type:

Write-up: Right after the technician administered both vaccines the patient reported he felt woozy and tried to put his head in-between his arms. Patient lost consciousness for about two to three seconds and regained consciousness on his own. When the patient lost consciousness, his body slid to the right side of the seat and the patient hit his head on the cabinet next to the chair. The patient did not fall onto the ground. 911 was called. Patient was monitored the entire time until EMS showed up. Patient denied any trouble breathing or swallowing or any pain. After the fact the patient told the pharmacy team that he normally passes out when he gets his blood drawn but he has never had a reaction or felt dizzy or fainted after a vaccine, so he did not mark that on his VAR form or mention anything ahead of time to the pharmacy team members. 911 was called a second time after they did not show up after about 15 minutes. Eventually about 45 to 60 minutes after the initial 911 call EMS showed up to the pharmacy. The patient was checked out by EMS. They checked his blood pressure and heart rate while sitting and standing, had his blood sugar checked and EMS manually checked the patient''s head. EMS warned the patient about potential risks after passing out from a vaccine and from hitting his head. The patient declined transport to the emergency department. EMS recommended that the patient notify his doctor that his blood pressure was slightly elevated but not to the point that he needed to be transported immediately to the emergency room. The patient left on his own. The patient''s healthcare provider office of DO was notified on Monday, 10/23/2023. The nursing staff stated that they would reach out to the patient as follow up to see how he is doing.


VAERS ID: 2726121 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Michigan  
Vaccinated: 2023-12-20
Onset: 2023-12-20
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 80777-0102-93 / 5 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 70461-0323-03 / N/A RA / IM
PNC20: PNEUMO (PREVNAR20) / PFIZER/WYETH 00005-2000-10 / N/A RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Fever
Other Medications: Flucelvax, prevnar, Lisinopril , medRoxyprogesterone , montelukast sodium and Ibuprofen.
Current Illness: Vaginal bleeding
Preexisting Conditions: High blood pressure , asthma
Allergies: NA
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Vomiting, upset stomach @11pm same night fever@ 1:30am 12/21/2023


VAERS ID: 2707320 (history)  
Form: Version 2.0  
Age: 3.0  
Sex: Female  
Location: Michigan  
Vaccinated: 2023-10-30
Onset: 0000-00-00
Submitted: 0000-00-00
Entered: 2023-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HH3252 / 3 LL / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 374407 / 3 RL / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dose administered, No adverse event, Product preparation 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: Flovent Inhaler has Atrovent PRN, but not using it lately
Current Illness: has chronic medical conditions below, but no acute illness at time of vaccination
Preexisting Conditions: Tracheo-esophageal fistula surgically repaired. bronchomalacia History of GERD (in remission) Atrial Septal Defect (asymptomatic) G tube feedings are main source of nutrition at this time as has had food aversion and working with feeding clinics
Allergies: no known allergies
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: NO ADVERSE reaction known. The medical assistant did not add correct amount of diluent to the vial of baby/young child covid vaccine prior to injection. She only added 0.1 ml of diluent and then administered 0.3 ml of the solution. I spoke to mother of child today. Child is fine and was fine yesterday. no fever. acting well. no adverse signs of symptoms.


VAERS ID: 1992307 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Michigan  
Vaccinated: 2021-12-22
Onset: 2021-12-23
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067H21A / 3 RA / UN
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 RA / UN

Administered by: Other       Purchased by: ?
Symptoms: Erythema, Headache, Hordeolum, Pyrexia, Swelling of eyelid
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Periorbital and eyelid disorders (narrow), Ocular infections (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: 102 degree fever Severe headache for more than 12 hours Swollen, red eyelid diagnosed as stye 1 day after


VAERS ID: 2101534 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Female  
Location: Michigan  
Vaccinated: 2022-01-25
Onset: 2022-01-25
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LL / IM
DTAPIPV: DTAP + IPV (QUADRACEL) / SANOFI PASTEUR C5970AA / UNK LL / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 75FZ7 / UNK RL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. U026799 / UNK RL / SC

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

Write-up: We administered the Pediatric COVID Vaccine after the thawed expire date.


VAERS ID: 2404262 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Michigan  
Vaccinated: 2021-10-27
Onset: 2022-07-31
   Days after vaccination: 277
Submitted: 0000-00-00
Entered: 2022-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 077C21B / 3 - / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308523 / N/A - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Dehydration, Dyspnoea, Fatigue, Hypoxia, Laboratory test normal
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (narrow), Dehydration (narrow), Opportunistic infections (broad), COVID-19 (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? Yes, 4 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen (TYLENOL ARTHRITIS EXT RELIEF PO) aspirin 81 MG tablet benzonatate (TESSALON) 100 MG capsule carvedilol (COREG) 12.5 MG tablet cholecalciferol (VITAMIN D, CHOLECALCIFEROL,) 25 MCG (1000 UT) tablet citalopram (CELEXA) 20 M
Current Illness: None
Preexisting Conditions: Encounter for long-term (current) use of other medications Osteoarthritis Coronary artery disease Hyperlipidemia Primary osteoarthritis involving multiple joints Other specified rheumatoid arthritis, multiple sites (HCC) Extensor intersection syndrome of both wrists Other synovitis and tenosynovitis, right upper arm Other synovitis and tenosynovitis, left upper arm Right tibialis tenosynovitis Horseshoe tenosynovitis of left hand Long term current use of systemic steroids Primary osteoarthritis of both knees Other specified rheumatoid arthritis, left hand (HCC) Other specified rheumatoid arthritis, right hand (HCC) Other specified rheumatoid arthritis, left wrist (HCC) Other specified rheumatoid arthritis, right wrist (HCC) Other specified rheumatoid arthritis, left elbow (HCC) Primary generalized hypertrophic osteoarthrosis Encounter for long-term (current) drug use Encounter for long-term (current) use of non-steroidal anti-inflammatories Pulmonary embolus (HCC) Transient ischemic attack (TIA) Cardiac pacemaker in situ Chronic diastolic heart failure (HCC) Complete heart block (HCC) Paroxysmal atrial fibrillation (HCC) Acute on chronic diastolic heart failure (HCC) Chest pain Rheumatoid arthritis (HCC) Essential hypertension Dyslipidemia Iron deficiency anemia, unspecified Pneumonia due to COVID-19 virus
Allergies: PenicillinsOther Sulfa DrugsOther
Diagnostic Lab Data:
CDC Split Type:

Write-up: Discharge Provider: MD Primary Care Provider: MD Admission Date: 7/31/2022 Discharge Date: Aug 4, 2022 PRESENTING PROBLEM: Hypoxia COVID-19 Pneumonia due to COVID-19 virus HOSPITAL COURSE: Patient is an 87-year-old female with a past medical history with rheumatoid arthritis on methotrexate comes in with shortness of breath and fatigue. She was found to have COVID-19, she was not hypoxic but very dehydrated. She was started on low-dose Decadron and remdesivir and responded well. She worked with PT/OT and did if finding. Recommendation was home physical therapy which was set up. Patient''s septic workup was negative. She tolerated diet well. Hemodynamically stable for discharge


VAERS ID: 2696142 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Minnesota  
Vaccinated: 2023-10-12
Onset: 2023-10-13
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AU3833D / N/A RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. AU3130B / N/A LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Arthralgia
SMQs:, Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Patient contacted our office 24 hours of receiving a vaccination. Patient was experiencing joint type pain at the shoulder. Denies radiating pain. Per patient the vaccine was given 2.5 finger width below the acromion process. Director suggested patient use NSAID''s and Ice to reduce any swelling. Recommended seeing primary care provider if pain increases. Followed up with Patient 48 hours after. Patient stated the pain has decreased, but not subsided. Patient is taking an NSAID and stated it has helped.


VAERS ID: 2696133 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Minnesota  
Vaccinated: 2023-10-11
Onset: 2023-10-11
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AU3833D / N/A RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. AU3130B / N/A LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Vaccination error, Wrong technique in product usage process
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: Director contacted patient and had patient return to the clinic on the same day and he received an accurate full dose of COVID vaccine.
CDC Split Type:

Write-up: Medication error- patient was given an injection with no vaccine, the injection only contained air.


VAERS ID: 2696132 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Minnesota  
Vaccinated: 2023-10-11
Onset: 2023-10-11
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AU3833D / N/A RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. AU3130B / N/A LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Medication 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: Director contacted patient and had patient return to the clinic on the same day and he received an accurate full dose of COVID vaccine.
CDC Split Type:

Write-up: Medication error- patient was given an injection with no vaccine, the injection only contained air.


VAERS ID: 2696123 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Minnesota  
Vaccinated: 2023-10-11
Onset: 2023-10-11
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AU3833D / N/A RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. AU330B / N/A LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Vaccination error, Wrong technique in product usage process
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: Director contacted patient and had patient return to the clinic on the same day and he received an accurate full dose of COVID vaccine.
CDC Split Type:

Write-up: Medication error- patient was given an injection with no vaccine, the injection only contained air.


VAERS ID: 2699766 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Female  
Location: Minnesota  
Vaccinated: 2023-10-21
Onset: 2023-10-21
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HF9298 / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944493 / UNK RA / 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: nka
Diagnostic Lab Data:
CDC Split Type:

Write-up: unknown - received adult dose rather than 5-11 dose by mistake.


VAERS ID: 2720617 (history)  
Form: Version 2.0  
Age: 2.0  
Sex: Male  
Location: Minnesota  
Vaccinated: 2023-11-24
Onset: 2023-11-24
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-12-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HH3252 / 1 LL / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 373195 / 1 RL / IM

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

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

Write-up: flu shot given 11/24/23 in error. Patient had already had flu shot 10/3/23. RN administering went to chart after the fact and realized pt had already gotten it. Called pt''s mom. Pt had no reaction


VAERS ID: 2715180 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Minnesota  
Vaccinated: 2023-11-11
Onset: 2023-11-11
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HF9298 / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370673 / 1 RA / IM

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

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

Write-up: Patient noticed she felt short of breath after the vaccination, but didn''t think too much of it. Thought maybe it was nerves. It went away. Then later that night, she developed very swollen lump in her armpit (lymph node) the size of a baseball. The following morning, she woke up with swollen eyes. She visited me on Monday and her eyes were still very swollen, and the swelling in her armpit was still very apparent and large (on the side she received the Comirnaty).


VAERS ID: 1974742 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Minnesota  
Vaccinated: 2021-12-20
Onset: 2021-12-20
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / UNK RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Pain, Pain in extremity, Peripheral swelling, Pruritus
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), 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: 2nd dose of the COVID-19 vaccine; same side effects; but only last 12 hours.
Other Medications: Spironolactone, Metformin, Birth Control, Citalopram
Current Illness:
Preexisting Conditions:
Allergies: Ceclor, Ragweed
Diagnostic Lab Data:
CDC Split Type:

Write-up: Red, swollen, itchy and painful arm with full body aches started around 7 pm; and lasted 30 hours.


VAERS ID: 1833420 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Minnesota  
Vaccinated: 2021-10-28
Onset: 2021-10-30
   Days after vaccination: 2
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 3 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308475 / 1 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Injection site erythema, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: redness, swelling and warmth to injection sites.


VAERS ID: 2708795 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Minnesota  
Vaccinated: 2023-09-27
Onset: 2023-09-27
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HG4659 / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944464 / N/A RA / IM

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

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

Write-up: Patient filled out form without stating history of fainting (only known after patient fainted and patient''s mother was contacted). Patient fainted after 5 minutes of vaccination as patient was walking out of the vaccination room. Patient was dizzy and "fainty." Called EMS for care and transport to ER due to possible head injury during fall.


VAERS ID: 1854501 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Minnesota  
Vaccinated: 2021-11-02
Onset: 2021-11-02
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Extra dose administered, Fatigue, Headache, Inappropriate schedule of product administration, Injection site pain, Pain, Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Birth control, Creon, Ferretts 325mg, Vitamin C, Magnesium Oxide 400mg, Acetaminophen, Zinc 30mg, Flonase nasal spray, Vitamin D, Melatonin, Calcium Carbonate 500mg chews, multivitamin, B-100, Vitamin B-12, allergy pill as needed
Current Illness:
Preexisting Conditions: Fibromyalgia, malabsorption
Allergies: Sulfa drugs, amoxicillin, NDSAIDs, Ferric Oxide, sensitivity to milk and pork
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approximately five hours after receiving the COVID-19 Modern booster and flu shot, I noticed hives on both arms; however, they did not itch or bother me. As expected, my arm had some soreness at the injection spot and I was tired. During the night (10-12 hours after receiving the vaccines, I woke up with a bad case of the chills and presumably a fever. When I got up in the morning, I had a fever but most of the hives had gone away. I took OTC acetaminophen and my fever went away as well. That day (after the vaccine), I had full body aches, was tired and weak, and had a dull headache.


VAERS ID: 1833379 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Minnesota  
Vaccinated: 2021-10-28
Onset: 2021-10-31
   Days after vaccination: 3
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 3 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308475 / 1 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Dizziness, Injection site discomfort
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)

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

Write-up: Dizziness and injection site discomfort.


VAERS ID: 2701615 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Minnesota  
Vaccinated: 2023-10-23
Onset: 2023-10-23
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Fatigue, Pyrexia
SMQs:, Anaphylactic reaction (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: Famotidine
Current Illness:
Preexisting Conditions: Dyslipidemia
Allergies: Sulfa products, azithromycin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extreme fatigue and fever, moderate cough


VAERS ID: 2705888 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Male  
Location: Minnesota  
Vaccinated: 2023-10-30
Onset: 2023-10-30
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AU5554B / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944492 / 1 LA / IM

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

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

Write-up: patient fainted in aisle after having shot. Was alert while pharmacist spoke with him. Patient felt dizzy and had blurred vision, but was able to see clearly right away. Paramedics cleared him.


VAERS ID: 2703312 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Minnesota  
Vaccinated: 2023-10-23
Onset: 2023-10-23
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 80777-0102-96 / 6 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 70461-0323-03 / 1 LA / IM

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

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

Write-up: Low grade fever, tired, body aches since night of vaccines-still currently experiencing


VAERS ID: 2278554 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Minnesota  
Vaccinated: 2021-12-30
Onset: 2022-01-15
   Days after vaccination: 16
Submitted: 0000-00-00
Entered: 2022-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3594 / 3 LA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308519 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Cold sweat, Disturbance in attention, Fatigue, Headache, Hot flush, Pain, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive, Somnolence
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (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: Mirtazapine; Buspar; omeprazole; vitamin B complex; vitamin B3
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: COVID tests, negative and positive tests.
CDC Split Type: vsafe

Write-up: 01/15/2022 I woke up and felt like I had not slept, I had extreme fatigue, body aches, headache, feverish, alternating hot flashes and cold sweats. Mainly the fatigue and body aches were the main symptoms. I took a home COVID test which was positive. This lasted for a week to 10 days. I then took a couple of more home COVID tests that were negative. I had trouble concentrating for a while after the other symptoms subsided. I started feeling fatigued again last month and felt similar as I did before with COVID. I had body aches and fatigue which lasted a few days. I also have congestion which could be allergies. I am waiting for the results of a COVID PCR test. I now feel 100% again.


VAERS ID: 2490154 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Minnesota  
Vaccinated: 2022-10-26
Onset: 2022-10-26
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AR6965B / 4 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 942439 / N/A LA / IM

Administered by: Pharmacy       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: unknown
Current Illness: unkown
Preexisting Conditions: unkown
Allergies: none
Diagnostic Lab Data: none at this time
CDC Split Type:

Write-up: Patient was given Moderna vaccine ndc 80777-975-05 instead of the updated booster. No adverse effects reported at this time.


VAERS ID: 2490139 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Minnesota  
Vaccinated: 2022-10-26
Onset: 2022-10-26
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AR69655B / 4 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 942439 / N/A LA / IM

Administered by: Pharmacy       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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was given Moderna vaccine ndc 80777-975-05 instead of the updated booster. No adverse effects reported at this time.


VAERS ID: 2695655 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Missouri  
Vaccinated: 2023-10-12
Onset: 2023-10-12
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AU3833D / UNK RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 674408 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heart rate increased, Hypertension, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypertension (narrow), 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: alprazolam, lisinopril
Current Illness: none disclosed
Preexisting Conditions: none disclosed
Allergies: codeine, psuedoephedrine
Diagnostic Lab Data: none
CDC Split Type:

Write-up: per pt, has higher than normal blood pressure (175-95), elevated heart rate (did not give value) and rash on stomach; per pt, she treated herself with tylenol and benadryl and issue resolved within 4-5 hours; pt says she is completely back to her "normal" today, but did want us to report


VAERS ID: 2712777 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Female  
Location: Missouri  
Vaccinated: 2023-11-11
Onset: 2023-11-11
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AU5554B / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370661 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Emotional disorder, Injection site pain, 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), Extravasation events (injections, infusions and implants) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: EMS checked patient''s blood pressure and heart rate was stated as "normal" by EMS and blood glucose 106 mg/dL. Patient''s mother (who is an OB-GYN) declined further care.
CDC Split Type:

Write-up: Patient received Covid pediatric vaccination (Moderna) in left arm without reaction. Then received Flu vaccine in right arm and lost consciousness for approximately 2-5 seconds at approximately 4:45 pm. She was in seated position and was maintained in position by administering pharmacy technician. When patient regained consciousness, she reported more pain during flu vaccination which caused an emotional response. 911 was immediately called and EMS arrived at approximately 4:55 pm. Patient''s blood pressure and heart rate was stated as "normal" by EMS and blood glucose 106 mg/dL. Patient''s mother (who is an OB-GYN) declined further care.


VAERS ID: 2709846 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Missouri  
Vaccinated: 2023-11-04
Onset: 2023-11-04
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3032218 / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370674 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Eye movement disorder, Hyperhidrosis, Immediate post-injection reaction, Posture abnormal, Somnolence, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None at time of vaccination. Prior illness unknown.
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 11/4/23 Blood pressure 86/64
CDC Split Type:

Write-up: Flucelvax was given first in the left deltoid, the patient responded fine. Then approximately 30 seconds later the Spikevax was administered, also in the left arm, approximately 2 inches away from the administration site of the Flucelvax. The patient''s head drooped forward immediately when the injection started going into the muscle. I then took the needle out to discontinue the administration. The patient had a full body rigor, head dropped back, her eyes rolled back in her head and she started shaking. The patients mother and I called her name and she was then alert, but drowsy and diaphoretic. 911 was called, blood pressure taken (86/64 ). I stayed with the patient and mom while we waited for emergency services to arrive. The patient was given some water and stayed alert until EMT''s arrived. Patient and mother were transported to Hospital Emergency Department.


VAERS ID: 2685990 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Missouri  
Vaccinated: 2023-09-19
Onset: 2023-09-24
   Days after vaccination: 5
Submitted: 0000-00-00
Entered: 2023-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HH7595 / N/A RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944465 / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Hypoaesthesia, Joint swelling, Pain, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Sexual dysfunction (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: Metformin, amlodipine, chlorthalidone, hydralazine, fluoxetine, quetiapine, lisinopril, atorvastatin,
Current Illness: None
Preexisting Conditions: Constipation, IBS, GERD, HTN
Allergies: NKA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient received vaccines on 9/19/23. On 9/24/23, patient noticed their right arm, wrist, and hand was swollen and was experiencing right shoulder pain with movement. Patient also reports numbness and lost feeling in the right hand which occasionally switches to the left hand. Patient has not tried any treatments for pain at time of report. Recommended patient take Tylenol as needed and ice and elevate arm.


VAERS ID: 2700535 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Missouri  
Vaccinated: 2023-10-23
Onset: 2023-10-23
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 8058877 / 1 LA / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944463 / 1 LA / -

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

Write-up: Tinnitus in right ear


VAERS ID: 1775119 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Missouri  
Vaccinated: 2021-10-08
Onset: 2021-10-08
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 AR / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Extra dose administered, Pain in extremity
SMQs:, Arthritis (broad), Tendinopathies and ligament disorders (broad), 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: Hydrocortisone, Fludrocortisone, vitamin C, Vitamin D, Phenergan, Pantropazole, Levothyroxine, Topiramate, Cimetedine
Current Illness: No
Preexisting Conditions: Addison?s disease, Hashimoto?s thyroiditis
Allergies: Vicodin, vicks vapor inhaler, vinyl gloves, Levaquin, Zithromax, Prednisone, Lidocaine, Percoset
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I received my third Pfizer (booster) Covid -19 shot at the same time as my annual flu shot. One vaccine was in my left arm, one in my right arm. My left arm hurt significantly worse. The night of the vaccine administration, I developed joint pain. The joint pain was significant in both of my knees. I could hardly sleep. I took Tylenol 500 mg x 2, but this did not affect the pain. On 10-9-2021 I took some 12 hour naproxen, ( 2 pills- max 3 in one day) and this helped significantly.


VAERS ID: 2699131 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Missouri  
Vaccinated: 2023-09-18
Onset: 2023-09-19
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Influenza like illness, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (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: Flu like symptoms for 1 - 2 days
Other Medications: Wellbutrin, Adderall
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sick with flu like symptoms for two days after vaccine. One month later, there is still a noticeable weakness in the arm that was used for the vaccination.


VAERS ID: 2258714 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Mississippi  
Vaccinated: 2022-02-22
Onset: 2022-02-22
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / UNK RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 309619 / UNK LA / IM

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

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

Write-up: N/A


VAERS ID: 1897780 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Mississippi  
Vaccinated: 2021-11-24
Onset: 2021-11-24
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1620 / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308451 / N/A RA / IM

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: none that i am aware of
Current Illness: none that i am aware of
Preexisting Conditions: none that i am aware of
Allergies: none that i am aware of
Diagnostic Lab Data: none that i am aware of
CDC Split Type:

Write-up: patient was administered both shots by pharmacy technician. He seemed fine and walked out to the waiting area for his wait time. He passed out but remained in his chair briefly about ten minutes later. EMTs came and checked him out, he seemed fine and his parents picked him up.


VAERS ID: 2699781 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Montana  
Vaccinated: 2023-10-09
Onset: 2023-10-10
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3031047 / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370651 / N/A LA / IM

Administered by: School       Purchased by: ?
Symptoms: Cardiac flutter, Hypoacusis, Palpitations, Tinnitus
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (narrow), 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: Prenatal women?s multivitamin Probiotic
Current Illness: Upper respiratory viral illness two weeks prior to vaccination. Headache, dry cough, fever, sore throat, fatigue, myalgias. Negative COVID test.
Preexisting Conditions: None
Allergies: Amoxicillin Shellfish
Diagnostic Lab Data: None
CDC Split Type:

Write-up: On 10/10/23, I got a sharp and sudden ringing in my right ear. I covered my ear with my hand and when I removed it, my hearing seemed quieter. Since then; I have been having difficulty hearing and have to watch people speak so I can figure out what is being said. I also had intermittent heart palpitations for one week after vaccines. I felt them especially when I was laying down and had a ?fluttering? sensation in my chest.


VAERS ID: 1801263 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Montana  
Vaccinated: 2021-10-18
Onset: 2021-10-18
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / UNK RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Fatigue, Nausea, Pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular 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: 28 -- 2nd covid Pfizer vaccine on 02/05/2021. Body aches and fever. Not too severe
Other Medications: Venlafaxine Metoprolol
Current Illness: None
Preexisting Conditions: None
Allergies: Shellfish - Mollusks
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Onset of symptoms occurred approximately 12 hours post vaccines. Symptoms include vomiting, nausea, extreme body aches, fever, chills, fatigue, and dizziness. Received a shot of Toradol and Zofran. Currently, at 48 hours post vaccines, nausea and vomiting are not present. Fever and chills comes and goes. Body aches have lightened in severity, (not crying due to pain anymore) but are still present. Fatigue and dizziness are still present./


VAERS ID: 2464709 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: North Carolina  
Vaccinated: 2022-09-29
Onset: 2022-09-29
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 057A22A / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 942383 / 1 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: the patient came in this morning for the bivalent updated moderna vaccine , I adminsterd the regular moderna , I spoke with the patient over the phone she is planning to come back after 2 months for the correct bivalent moderna


VAERS ID: 1787930 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: North Carolina  
Vaccinated: 2021-10-14
Onset: 2021-10-14
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / UNK - / -

Administered by: Work       Purchased by: ?
Symptoms: Dizziness, Nausea, Taste disorder
SMQs:, Acute pancreatitis (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: BP 148/98 (standard for pt)
CDC Split Type:

Write-up: Pt reported severe dizziness and nausea. Also mentioned odd taste in mouth. Was evaluated by EMS and determined to be non-emergent.


VAERS ID: 1858466 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: North Carolina  
Vaccinated: 2020-11-10
Onset: 2021-11-10
   Days after vaccination: 365
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 066F21A / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 309615 / N/A RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Feeling abnormal
SMQs:, Dementia (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 complained of throat "feeling funny" about 5 -10 minutes post vaccine admin but did not complain of problems breathing or swallowing. Administered 25mg of diphenhydramine by mouth. Continued to closely monitor. Patient was alert and continued to improve after administration of diphenhydramine over the course of approximately 30 minutes after admin.


VAERS ID: 2705312 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: North Carolina  
Vaccinated: 2023-10-27
Onset: 2023-10-27
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3030498 / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944482 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Tinnitus
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: Had ringing in the right ear occur/start at 7pm the night of his vaccines which he got around 10am that morning. The ringing in the right has not gone away and is persistent.


VAERS ID: 2705313 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: North Carolina  
Vaccinated: 2023-10-21
Onset: 2023-10-24
   Days after vaccination: 3
Submitted: 0000-00-00
Entered: 2023-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3031281 / 5 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370665 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prozac, xanax, multi vitamin, probiotics, d3
Current Illness: None
Preexisting Conditions: None
Allergies: Caffeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen top lip


VAERS ID: 2717783 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: North Carolina  
Vaccinated: 2023-11-25
Onset: 2023-11-25
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HF9300 / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944496 / UNK RA / IM

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

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

Write-up: A few minutes after the patient received the vaccine, the patient reported feeling weird and fuzzy. She looked pale, and I had her lie down in the immunization room. As she was lying down, she fainted for a moment or two. She became conscious after a moment. I had her lay down for awhile, and then sit for about 10 more minutes. Once she was feeling normal again, her mother took her home.


VAERS ID: 2705453 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: North Carolina  
Vaccinated: 2023-10-19
Onset: 2023-10-19
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AU3832B / N/A LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. AU3130B / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Sleep disorder, Tremor, Trismus
SMQs:, Neuroleptic malignant syndrome (broad), Dystonia (narrow), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: First Pfizer shot - heart racing age 40
Other Medications: VSL #3, Mag Citrate, Fish Oil, Multivitamins, sulfamethoxazone-tmp
Current Illness:
Preexisting Conditions: IBS
Allergies: Wheat Casin Lactose Bee Stings
Diagnostic Lab Data:
CDC Split Type:

Write-up: While asleep woken up with jaw locked and body shaking. Duration = a couple of minutes. Had second shorter event the next morning 15-20 secs during nap and awakened again. No issues since then.


VAERS ID: 2444686 (history)  
Form: Version 2.0  
Age: 3.0  
Sex: Female  
Location: North Carolina  
Vaccinated: 2022-09-13
Onset: 2022-09-13
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FT9142 / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 348364 / N/A RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect dose administered, Intentional medical device removal by patient, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: ADMINISTRATION ERROR - Patient received full dose of Covid19 vaccine in left arm (deltoid). When pharmacist went to administer flu vaccine in right arm (deltoid), patient pulled away after needle entered skin and approx. 1/4 of dose was administered. Patient''s father was present for administration and after discussing with 3 y.o. patient, decided she was not amicable to receiving rest of dose and therefore vaccine was incomplete. Pediatrician was made aware via fax and state registry updated with incomplete dose information. No adverse reaction.


VAERS ID: 2467039 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: North Carolina  
Vaccinated: 2022-10-01
Onset: 2022-10-01
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 064A22A / 3 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 942439 / 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: liver disease, IBS, hepatic tumors
Allergies: codeine,coconut,gadavist
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient was to receive Moderna Bivalent; instead Moderna Pediatric age 6-11 was administered


VAERS ID: 2140535 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: North Carolina  
Vaccinated: 2022-02-17
Onset: 2022-02-20
   Days after vaccination: 3
Submitted: 0000-00-00
Entered: 2022-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003J21A / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308452 / UNK RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol 90 mcg/actuation inhaler amphetamine-dextroamphetamine (ADDERALL XR) 20 MG 24 hr capsule ascorbic acid, vitamin C, (VITAMIN C) 500 MG tablet B complex-vitamin C-folic acid (FOLBEE PLUS) 5 mg tab biotin 10,000 mcg cap BL
Current Illness: none
Preexisting Conditions:
Allergies: scopalamine augmentin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt reports HA 48 hours after vaccine administration that has continued for the last 5 days.


VAERS ID: 2699098 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: North Carolina  
Vaccinated: 2023-09-28
Onset: 2023-09-28
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HG2282 / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944465 / N/A RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immunisation reaction
SMQs:

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

Write-up: Idiopathic response after vaccination.


VAERS ID: 2710817 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: North Carolina  
Vaccinated: 2023-11-07
Onset: 2023-11-07
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HL9298 / 1 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 375291 / N/A RA / IM

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: None indicated at time of vaccination and none taken from our pharmacy currently
Current Illness: none indicated
Preexisting Conditions:
Allergies: none indicated
Diagnostic Lab Data:
CDC Split Type:

Write-up: Child passed out shortly after the second vaccine was administered, similarly to their sibling. The Covid shot was administered first, followed by the flu shot. EMS called but children regained consciousness. No transport to medical facility was given.


VAERS ID: 2720875 (history)  
Form: Version 2.0  
Age: 0.58  
Sex: Female  
Location: North Carolina  
Vaccinated: 2023-12-01
Onset: 2023-12-02
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-12-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LL / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 LL / IM

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Fatigue, Hypophagia, Malaise, Pyrexia, Rash, Skin warm
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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: Reflux
Preexisting Conditions: Milk protein allergy
Allergies: Cow Milk Protein Allergy
Diagnostic Lab Data: None yet. Appointment with doctor on 12/5
CDC Split Type:

Write-up: Fever $g102 for 2 days, redness (sunburn looking) and hot to the touch, rash on arms, legs, and back. Malaise, tiredness, eating less


VAERS ID: 2738785 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: North Carolina  
Vaccinated: 2024-01-23
Onset: 2024-01-23
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2024-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 208F23A / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 374143 / N/A RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fall, Head injury, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient was dizzy after receiving vaccines (no history of reaction). Patient fell into chair in waiting area, hitting her head on the nearby wall (did not fall out of the chair). After 30-60 seconds, patient become unresponsive to verbal/physical stimuli in a seated position for 30-60 seconds (patient continued breathing/ pulse detectable). Regained consciousness, oriented to person, place, time, situation. EMS called per mother''s request, transported to hospital.


VAERS ID: 2187637 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: North Carolina  
Vaccinated: 2021-10-01
Onset: 2021-10-01
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Immediate post-injection reaction, Loss of personal independence in daily activities, Mobility decreased, Myalgia, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Dementia (broad), Parkinson-like events (broad), Eosinophilic pneumonia (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? No
Hospitalized? No
Previous Vaccinations: COVID Vaccine #2
Other Medications: Don''t remember. Same as prior event report.
Current Illness: None
Preexisting Conditions: Bipolar I, PTSD, Generalized Anxiety, Idiopathic Degenerative Small Fiber Neuropathy, Fibromyalgia, S.I. Joint Arthritis, Unspecified Severe Lower Back Pain, Permanent Plantar Fasciitis
Allergies: Lamictal, Geodon, Tegretol, Betadine, Iodine
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pain and limited mobility in right upper arm starting immediately or day after injections. I struggle to get dressed, undressed, and reach certain areas (i.e. reaching across, over, or behind my shoulder) WTH my right upper arm. I also have bicep pain in the same arm.


VAERS ID: 1907173 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: North Carolina  
Vaccinated: 2021-11-05
Onset: 2021-11-19
   Days after vaccination: 14
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032F21A / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 309613 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Herpes zoster, Pain, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (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: Effexor 225mg/day Vitamin D
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin Amoxicillin
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Singles / rash on lower back and left leg. Shooting pains and soreness down left side. Throbbing pain behind rash on knee.


VAERS ID: 1942865 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: North Carolina  
Vaccinated: 2021-12-09
Onset: 2021-12-12
   Days after vaccination: 3
Submitted: 0000-00-00
Entered: 2021-12-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pruritus, Injection site swelling, Pruritus, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Gabapentin 600mg Cymbalta 60mg Ambien 10mg
Current Illness:
Preexisting Conditions: PCOS PTSD Depression
Allergies: Lamictal (rash)
Diagnostic Lab Data:
CDC Split Type:

Write-up: I received both vaccines Thursday afternoon; by end of day had mild swelling and itching at left arm injection site. When I woke Sunday morning I had severe itching and red rash on face, neck, throat, and ears. By afternoon spread to chest and arms. After a dose of Benadryl itching ceased though rash remained.


VAERS ID: 2709945 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: North Carolina  
Vaccinated: 2023-11-05
Onset: 2023-11-05
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3032169 / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 999492 / 1 RA / IM

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

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

Write-up: Patient complained of lightheadedness, clammy skin, sweating, and headache. I had patient sit, gave him a sugary drink, and a cool compress for his neck. He felt better in about 5 minutes


VAERS ID: 2467036 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: North Carolina  
Vaccinated: 2022-10-01
Onset: 2022-10-01
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 064A22A / 5 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 942439 / 1 RA / IM

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

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

Write-up: The patient was to get Moderna Bivalent; instead Moderna Pediatric age 6-11 was administered


VAERS ID: 2710322 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: North Carolina  
Vaccinated: 2023-10-17
Onset: 2023-10-17
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3030535 / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. AU313OB / N/A RA / 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: none
CDC Split Type:

Write-up: pt did NOT have any type of adverse event. After giving the vaccine, it was realized that vaccine was only approved for 12 years and older. pt received a full dose of the spikevax (0.5ml) instead of 0.25ml, which is the recommended dose.


VAERS ID: 2710811 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: North Carolina  
Vaccinated: 2023-11-07
Onset: 2023-11-07
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HE2391 / 1 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 375291 / N/A RA / -

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: none on file or stated at time of vaccination
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: passed out shortly after being administered the second vaccine (flu vaccine).


VAERS ID: 2694989 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: North Carolina  
Vaccinated: 2023-10-12
Onset: 2023-10-12
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AU5555B / N/A RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370661 / N/A - / IM

Administered by: Work       Purchased by: ?
Symptoms: Failure to thrive
SMQs:, Neonatal 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: no known
Current Illness: none known
Preexisting Conditions: none per VAR vaccine administration record
Allergies: NKA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient fainted less than 5 minutes after vaccination. She recovered less than 5 minutes later


VAERS ID: 2000019 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Nebraska  
Vaccinated: 2022-01-03
Onset: 2022-01-03
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078J21A / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308492 / 1 RA / IM

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: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: PATIENT FIRST RECEIVED MODERNA BOOSTER SHOT, THEN GOT FLU SHOT NEXT AND PASSED OUT ABOUT 1-2 MINUTES AFTER FLU SHOT FOR A TOTAL OF ABOUT 5 SECONDS. PT WAS SUPPORTED IN A CHAIR AND DID NOT INJURE HERSELF.


VAERS ID: 1924048 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Nebraska  
Vaccinated: 2021-09-03
Onset: 2021-10-22
   Days after vaccination: 49
Submitted: 0000-00-00
Entered: 2021-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 2 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysmenorrhoea, Heavy menstrual bleeding, Menstruation delayed, Menstruation irregular, Muscle spasms, Thrombosis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Dystonia (broad), Thrombophlebitis (broad), Fertility 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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Irregular menses, period has always been very regular and same amount of days every month. After getting the 2nd dose of the COVID-19 vaccine my menses has been extremely irregular and painful. October 22, 2021 I started my menses which was a day late, and lasted three days. I had intolerable cramping. Ended October 24, 2021. November 17 I started my menses on the 17 and it lasted until November 21st. This was a total of five days earlier than my normal regular menses and was a day longer than my normal menses. Again I had intolerable cramping and lots of small blood clots.


VAERS ID: 2493459 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Nebraska  
Vaccinated: 2022-10-27
Onset: 2022-10-27
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 4 LA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / N/A LA / SYR
VARZOS: ZOSTER (SHINGRIX) / GLAXOSMITHKLINE BIOLOGICALS - / N/A RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Decreased appetite, Dizziness, Fatigue, Headache, Hyperhidrosis, Injection site pain
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin 40mg daily Lisinopril 40mg daily Hydrochlorothiazide 25mg daily
Current Illness:
Preexisting Conditions: Hypertension and high cholesterol
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sore arm at injection site a few hours after injection Chills, headache, joint soreness, fatigue, lack of appetite, dizziness started on 10/28. Treated with total of ibuprofen 1200mg, naproxen 880mg, 500mg aspirin, 500mg acetaminophen over the course of the 28th and 29th. No noticeable changes, but some sweating started in the evening on the 29th.


VAERS ID: 2706116 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: New Hampshire  
Vaccinated: 2023-10-30
Onset: 2023-10-30
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944484 / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dehydration, Dizziness, Fall, Loss of consciousness, Posture abnormal, Skin abrasion, Skin laceration, Tremor
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), Dystonia (broad), Parkinson-like events (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), Dehydration (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: claims to get "nauseous and lightheaded", but denied any previous syncope during vaccinations
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: Hx of syncope (no hx after a vaccination)
Allergies: N/A
Diagnostic Lab Data: PT declined further medical evaluation, refused transport to a local hospital.
CDC Split Type:

Write-up: Pt received her flu shot in her left deltoid, during administration of her COVID Spikevax in her right deltoid, she began to appear shaky, her head sunk forward and she slumped forward out of her chair, her fall was slowed as an attempt to catch the patient was made. Upon impacting the ground the patient "came to". Pt was evaluated and was discovered to have a small laceration on her forehead (carpet burn), but otherwise no outward signs of injury. Pts BP was 79/48, she presented as lightheaded and claimed she was "probably dehydrated". Pt was given a bottle of water and allowed to rest for several minutes, after approx 5 minutes time, pt wanted to return to her chair. She was assisted to her chair by her mother, myself (pharmacist), and my technician whom had administered the vaccines.


VAERS ID: 2701185 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: New Hampshire  
Vaccinated: 2023-10-14
Onset: 2023-10-17
   Days after vaccination: 3
Submitted: 0000-00-00
Entered: 2023-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HD9835 / UNK LA / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 374408 / N/A RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Oral herpes, Stomatitis
SMQs:, Severe cutaneous adverse reactions (broad), Oropharyngeal infections (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (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 reporting multiple oral sores and fever blisters on lips 3 days after co-administration of flu and covid vaccine


VAERS ID: 2714704 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: New Hampshire  
Vaccinated: 2023-11-16
Onset: 2023-11-16
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3030949 / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370656 / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Paraesthesia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (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: After the vaccines he fainted and his father caught him preventing him from hitting his head. He regained consciousness in less than a minute and described feeling dizzy before fainting then tingling in his hands. We had called 911 and upon examination determined all vitals were normal and the patient and his father left.


VAERS ID: 2705402 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: New Jersey  
Vaccinated: 2023-10-28
Onset: 2023-10-28
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 00069-2362-10 / 1 RA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 70461-0323-03 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Respiratory rate increased
SMQs:

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

Write-up: Not long after going to bed I had chills and I was unable to slow down my breathing. The chills may have lasted a few hours. I don''t know how long my respiration was fast.


VAERS ID: 2696842 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: New Jersey  
Vaccinated: 2023-10-16
Onset: 2023-10-16
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HG4671 / N/A LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370661 / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyskinesia, Feeling cold
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dyskinesia (narrow), Noninfectious encephalopathy/delirium (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: none as per form
Preexisting Conditions: none as per form
Allergies: none as per filled form
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt was tensed and very anxious and was accompanied by grand parents to get flu and covid shot, right after shot pt had jerk and lay down on the floor. He was feeling dizzy and little cold. Rph checked and called 911 and monitored pulse and respiration which was normal through out. Pt was responsive and talking all the time. Was given gatorade to drink and EMS took over.


VAERS ID: 1850822 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: New Jersey  
Vaccinated: 2021-10-24
Onset: 2021-10-24
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 3 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308485 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Amnesia, Hyperhidrosis, Loss of consciousness, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Parkinson-like events (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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: after administrating second shot customer customer become extremely sweaty and start to shake . it last about 1 minute. he wake up from this right away and start asking whats happend to him. he said he was really anxious about shots and was very nervous. he described it as anxiety attact. i call 911 and emt came in 5 minutes. customer was siting in immunization room and i provide him with bottle of cold water. emt service checked the patient. all his vitals were normal bp, heart rate, they ask him if he wanted to go to hospital and patient said no. he moved to sit my pharmacy department another 20 minutes then he went home


VAERS ID: 1873078 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: New Jersey  
Vaccinated: 2021-11-10
Onset: 2021-11-11
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 3 LA / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. UNKNOWN / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthritis, Chest discomfort, Chest pain, Chills, Condition aggravated, Delirium, Discomfort, Electrocardiogram normal, Extra dose administered, Headache, Mobility decreased, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Arthritis (narrow), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Immune-mediated/autoimmune 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: Moderna Dose Two dated 3/14/21. Fever, body aches, etc...
Other Medications: Super B Vitamin C Vitamin D Biotin Omega 3 Fish Oil
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: EKG - normal
CDC Split Type:

Write-up: Fever (100.8), headache, chills, delirium, body aches including chest pains. From 8AM to 8PM on 11/11/2021 I could not get out of bed, fall asleep and was shivering uncontrollably. My main concern was the feeling of pressure in my chest. At 8PM my fever began lowering and I was able to fall asleep. On 11/12/2021 I was examined at Hospital, byt Doctor who reported that the joints connecting my sternum were inflamed due to vaccine which created the feeling of discomfort. I was starting to feel better by the end of the day.


VAERS ID: 1942322 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: New Jersey  
Vaccinated: 2021-12-10
Onset: 2021-12-11
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2021-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Musculoskeletal stiffness, Oropharyngeal pain, Pain in extremity
SMQs:, Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad), Tendinopathies and ligament 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: Injection site reaction, 05212021, moderna covid #2
Other Medications: Elidel
Current Illness: None
Preexisting Conditions: Vitiligo
Allergies: Mushrooms
Diagnostic Lab Data:
CDC Split Type:

Write-up: Right arm stiffness and soreness, fatigue, sore throat


VAERS ID: 2692591 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: New Jersey  
Vaccinated: 2023-10-06
Onset: 2023-10-06
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 209F232A / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 374671 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Gaze palsy, Malaise, Seizure, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Ocular motility disorders (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: no
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient came in around 4:45pm to receive a seasonal flu vaccine and Spikevax covid 19 vaccine 2023-2024 While elvaulating the consent form, patient informed me that he has a vasovagel event last year when receiving his vaccinations. He was cleared by the emergency room department ,stating that it was not believed to be an allergic reaction. Patient was accompanied by his parents. The patient wanted to proceed with vaccination, within in 1 to 2 minutes patient stated he did not fill well, rolled his eyes and fainted. He woke up immediately but then had a brief seizure. EMS was called immediately. Patient was able to tell us his DOB and was responding. The paramedics evaulated him. Helwent to the hospital .


VAERS ID: 2021994 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: New Jersey  
Vaccinated: 2021-12-27
Onset: 2022-01-07
   Days after vaccination: 11
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028K21A / 3 RA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye swelling, Pain in extremity, Pruritus, Rash, SARS-CoV-2 test negative, Swelling, Swelling face, Type IV hypersensitivity reaction, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ezetimibe, Atorvistatin, Losartan, Metropolol
Current Illness: None
Preexisting Conditions: Sjogren''s Syndrome
Allergies: None
Diagnostic Lab Data: Rapid COVID test - NEGATIVE
CDC Split Type:

Write-up: On January 7th, 2022, 11 days after the flu and COVID vaccines were administered; I began to notice an uncontrollable itch in my groin area as well as shoulders and head. The itch became more severe throughout the day and hives began to appear along with rashes. These were at various locations on my body. I began to develop an uncontrollable itch and pain in the palms of my hands. Later that day I took a benadryl tablet which alleviated some of the itchiness. By that evening I noticed distinct hives developing around the outside of my face, jawline, temple, shoulders and neck. My eyes began to swell. The next day, January 8th, 2022, I visited the local urgent care facility. My body and face still covered in hives and rash. My jaw and neck began to swell at this point from my temples down. I was given a COVID rapid test which was NEGATIVE. The physician felt this was a result of a delayed reaction from the vaccine. I was prescribed a methylprednisolone dosepak (6 days, series of 4mg tablets) and began taking Zyrtec for the itch. after 2 days taking the prescribed medication I began to notice less rash and hives. The swelling began to subside after the second day and the itching is almost irrelevant. At this time (January 10th, 2022) I am noticing sporadic rash activity in different parts of my body but with very limited duration. The itchiness is almost completely gone and the swelling around my jam and neck is 90% resolved.


VAERS ID: 2553792 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: New Mexico  
Vaccinated: 2022-10-28
Onset: 2022-10-28
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FP7135 / 4 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 942410 / N/A LA / IM

Administered by: Unknown       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: Incorrect vaccine type, administered monovalent COVID19 dose instead of bivalent


VAERS ID: 2713577 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Male  
Location: New Mexico  
Vaccinated: 2023-11-11
Onset: 2023-11-11
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AU5554B / UNK RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 375291 / UNK LA / IM

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

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

Write-up: MOM WAS WITH PT INSIDE IMZ BOOTH. HE RECEIVED BOTH VACCINES. PT WAS NERVOUS AND MOM HELPED TO CALM HIM DOWN. HIS MOTHER ASKED HIM TO GO TO HIS FATHER. HIS FATHER WAS STANDING OUTSIDE THE IMZ BOOTHE. HE WALKED OVER TO HIS FATHER AFTER IMZ. I WAS THEN ABOUT TO GIVE HIS MOM AN IMZ ABOUT A MINUTE LATER WHEN I HEARD A COMMOTION OUTSIDE THE IMZ BOOTH. PT WAS LAYING ON THE FLOOR TRYING TO GET UP. HIS FATHER WAS KNEELING BESIDE HIM TELLING HIM TO STAY ON THE FLOOR. HIS FATHER SAID HE FAINTED. HE ASKED FOR SOMETHING WITH SUGAR. I GAVE THE FATHER A ROOT BEER SODA AND A PACKET OF YOUGURT. THE FATHER KEPT THE PT ON THE FLOOR FOR ABOUT 10 MINS. HE HAD HIM DRINK SOME OF THE SODA AND CONSUME SOME OF THE YUOGURT.


VAERS ID: 2709982 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: New Mexico  
Vaccinated: 2023-11-03
Onset: 2023-11-03
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3030949 / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944481 / UNK RA / IM

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

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

Write-up: Pt was only expecting flu vaccine and received covid vaccine instead. Was then given flu vaccine after mistake discovered.


VAERS ID: 2563527 (history)  
Form: Version 2.0  
Age: 4.0  
Sex: Male  
Location: New Mexico  
Vaccinated: 2023-01-19
Onset: 2023-01-19
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-01-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FX5095 / 2 LL / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. AS1594B / 3 RL / IM

Administered by: Private       Purchased by: ?
Symptoms: Rash, Rash erythematous, Rash papular, Rash pruritic, Streptococcus test negative, 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Conjunctivitis
Preexisting Conditions: None
Allergies: none known
Diagnostic Lab Data: 01/19/2023 Rapid Strep done in office-Negative 01/19/2023 Referral to allergist ordered, Epi Pen RX 01/20/2023 Pt to follow up in office tomorrow
CDC Split Type:

Write-up: 10 minutes after receiving Influenza and COVID vaccines patient developed urticarial type rash to trunk, face and extremities. Patient with welts to face under eyes and several raised red areas to arms, shoulders and trunk. + pruritic . No respiratory distress or lip, tongue, throat involvement noted. O2 sats 99%, heart rate 106, respirations 28. Patient was given Benadryl 1 mg/kg po, and then Prednisolone 1 mg/kg about 15 minutes later and observed x 1 hour. Rash started to resolve about 30 minutes after prednisolone given. Vital signs on discharge HR 88, Respirations 24, O2 sats 99.


VAERS ID: 2553931 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: New Mexico  
Vaccinated: 2022-10-28
Onset: 2022-10-28
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FP7135 / 5 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 942410 / 5 LA / IM

Administered by: Unknown       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: Incorrect vaccine type, administered monovalent COVID19 dose instead of bivalent


VAERS ID: 2715416 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: New Mexico  
Vaccinated: 2023-11-17
Onset: 2023-11-17
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA SPIKEVAX203623A / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Nausea, Pain, Seasonal allergy
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Conjunctival disorders (narrow), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Moderna
Other Medications: Loratadine, levothyroxine, liothyronine, fluticosone, finacea
Current Illness: No
Preexisting Conditions: Seasonal allergies all year and animal allergies
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Severe body aches, headache, slight nausea, no treatment


VAERS ID: 1959184 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Female  
Location: New Mexico  
Vaccinated: 2021-12-17
Onset: 2021-12-17
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 2 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. UT7347MA / 1 LA / IM

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: Claritin 10mg tablet
Current Illness: none
Preexisting Conditions: none
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pfizer Covid-BioNTech 0.2ml dosage was given without reconstitution


VAERS ID: 2709866 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: New Mexico  
Vaccinated: 2023-10-20
Onset: 2023-11-02
   Days after vaccination: 13
Submitted: 0000-00-00
Entered: 2023-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3031417 / 4 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370651 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Autopsy, Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-11-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin 1000mg BID Lisinopril 20mg daily
Current Illness: none
Preexisting Conditions: poorly-controlled diabetes type 2 hypertension
Allergies: NKDA
Diagnostic Lab Data: None yet - autopsy is pending
CDC Split Type:

Write-up: This patient died unexpectedly in her sleep on the night of November 1st, 2 days after she received her flu vaccine and COVID booster in our clinic.


VAERS ID: 2705523 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: New Mexico  
Vaccinated: 2023-10-24
Onset: 2023-10-27
   Days after vaccination: 3
Submitted: 0000-00-00
Entered: 2023-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 8058877 / 4 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 374409 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Chills, Gait disturbance, Hot flush, Muscular weakness, Pain, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Birth control pills
Current Illness: Minor cold about a week before vaccination
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None at this time
CDC Split Type:

Write-up: Initially just soreness of the right arm and nothing else. On Friday, 3 days after receiving the vaccines, she started having severe body aches. On Saturday and today she can barely walk due to aches and weakness in her left leg. She has had some chills/ hot flashes but no fever. Taking over the counter ibuprofen and Tylenol without much relief.


VAERS ID: 2196320 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Nevada  
Vaccinated: 2022-01-25
Onset: 2022-01-27
   Days after vaccination: 2
Submitted: 0000-00-00
Entered: 2022-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33025BD / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308497 / 1 RA / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Immunisation reaction
SMQs:

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

Write-up: Spoke with son and power of attorney on 3/21/22 to schedule his mother''s second dose of the covid-19 vaccine, and he stated that she was not the same since the vaccination on 1/25/22.


VAERS ID: 2029554 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Nevada  
Vaccinated: 2022-01-12
Onset: 2022-01-12
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8762 / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308490 / N/A LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Amnesia, Loss of consciousness, Nervousness, Pain, 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), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: no
Preexisting Conditions: no
Allergies: none reported
Diagnostic Lab Data: Pt mother present and stated pt has had syncopal episode previously with venipunture blood draws.
CDC Split Type:

Write-up: pt was very anxious and nervous about needles and had syncopal episode after vaccination. pt unconscious for about 30 seconds, then came to. pt remembered vaccine administration and pain, but had no recollection of fainting. once pt arousable, pt a/o x 3, stated she just felt shaky. vss 108/62, rr 16, hr 66.


VAERS ID: 2707359 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: New York  
Vaccinated: 2023-10-31
Onset: 2023-10-31
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 202G23-2A / N/A LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944496 / N/A RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aphasia, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant 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), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (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: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Pt has a history of anxiety about receiving vaccines. She informed us she would faint "I usually feel a bit light-headed after taking shots". While giving the shots, I spoke with her to keep her engaged but after the second shot, she fainted. No speaking, eyes wide open, unresponsive, and her breathing was steady. I monitored her for breathing and tried waking her up. She returned to normal after 10 seconds


VAERS ID: 1783807 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: New York  
Vaccinated: 2021-10-11
Onset: 2021-10-12
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 3 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary 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? 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: Pain in armpit after 24 hours, swollen lymph nodes


VAERS ID: 2554518 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: New York  
Vaccinated: 2022-10-20
Onset: 2022-10-24
   Days after vaccination: 4
Submitted: 0000-00-00
Entered: 2023-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH GJ6739 / 4 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 348374 / N/A RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Amenorrhoea, Fatigue, Pregnancy test negative
SMQs:, Fertility disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pfizer booster 3- cardiac issues
Other Medications: Adderall, viibryd, spirolactone
Current Illness:
Preexisting Conditions:
Allergies: Keflex
Diagnostic Lab Data: Pending
CDC Split Type:

Write-up: Menstrual cycle ceased . None since administration of bivalent (2 cycles) , negative pregnancy test. Fatigue


VAERS ID: 1759421 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: New York  
Vaccinated: 2021-09-24
Onset: 2021-09-30
   Days after vaccination: 6
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 3 AR / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pruritus, Sleep disorder, 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Medformin 1000MG, Simvastatin 20MG, Baby Aspirin 59mg, Glipiside 5 MG
Current Illness: Diabetes
Preexisting Conditions: Diabetes, Asthma
Allergies: NONE until 9/30
Diagnostic Lab Data: physician exam
CDC Split Type:

Write-up: Approx 1 week after receiving both vaccines, hives started on ankles and proceeded up body. Last two nights could not sleep account hives itching. Ruled out bugs account spouse sleeping in same bed with no hives.


VAERS ID: 2692777 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: New York  
Vaccinated: 2023-10-06
Onset: 2023-10-06
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site rash, Injection site warmth
SMQs:, Hypersensitivity (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 called today saying she has a rash and hot to touch at injection site. pt received both spikevax and flucelvax in the left arm


VAERS ID: 2503308 (history)  
Form: Version 2.0  
Age: 0.58  
Sex: Female  
Location: New York  
Vaccinated: 2022-11-08
Onset: 0000-00-00
Submitted: 0000-00-00
Entered: 2022-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AR9236B / 2 LL / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 348377 / 3 RL / IM

Administered by: Work       Purchased by: ?
Symptoms: Extra dose administered, 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: Not known
Current Illness: None
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Mother came to vaccine clinic with child. Requested 2nd dose of Moderna Infant/Toddler vaccine and second Influenza vaccine. Vaccine card showed previous Moderna vaccine given 10/5/2022. Vaccines given. When documenting, noted that a prior dose of Influenza vaccine was given 9-14-2022 in provider office.


VAERS ID: 1905349 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: New York  
Vaccinated: 2021-11-27
Onset: 2021-11-28
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 03H121A / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 70461032103 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Hypersomnia, Injection site pain, Pain
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Depression (excl suicide and self injury) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None.
Current Illness: None.
Preexisting Conditions: Allergic to dust/smoke; mild psoriasis (although that''s been clear for more than a year).
Allergies: Mild reaction to acetaminophen when taking as directed on over-the-counter versions more than twice in a day.
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Moderna COVID?19 Vaccine EUA: Injection site pain began within a few hours on Friday. Mild underarm pain began around 12:20 a.m. Saturday as I was getting to sleep, about 11.5 hours after the shot. It was uncomfortable raising my left hand over my head in the morning, about 8 a.m. Sunday. When going to sleep around 11 p.m. Sunday, the pain had worsened, making sleep uncomfortable. Around 2 a.m. Monday (today), I touched my underarm and it was painful to the touch.


VAERS ID: 2742639 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: New York  
Vaccinated: 2023-12-30
Onset: 2023-12-30
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2024-01-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032265 / 4 RA / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370674 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Accidental overdose, Body temperature, Brain fog, Extra dose administered, Influenza like illness, Injection site pain
SMQs:, Drug abuse and dependence (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), 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: Medical History/Concurrent Conditions: COVID-19
Allergies:
Diagnostic Lab Data: Test Name: Body temperature; Result Unstructured Data: Patient did not have fever as measured with a thermometer.
CDC Split Type: USMODERNATX, INC.MOD20247

Write-up: Flu like symptoms included: generalized body aches, shivers, sweating; Muscle Pain at injection site; they accidentally administered 2 doses of Spikevax of 0.5 ml each to an adult patient; they accidentally administered 2 doses of Spikevax of 0.5 ml each to an adult patient; Brain fog; This spontaneous case was reported by a pharmacist and describes the occurrence of BRAIN FOG (Brain fog), INFLUENZA LIKE ILLNESS (Flu like symptoms included: generalized body aches, shivers, sweating), INJECTION SITE PAIN (Muscle Pain at injection site), EXTRA DOSE ADMINISTERED (they accidentally administered 2 doses of Spikevax of 0.5 ml each to an adult patient) and ACCIDENTAL OVERDOSE (they accidentally administered 2 doses of Spikevax of 0.5 ml each to an adult patient) in a 34-year-old male patient who received mRNA-1273.815 (SPIKEVAX 2023-2024) (batch nos. 032265 and 032265) for COVID-19 prophylaxis. Co-suspect product included non-company product INFLUENZA VACCINE INACT SAG 4V (FLUCELVAX QUAD) for an unknown indication. The patient''s past medical history included COVID-19 on 28-Dec-2020. Previously administered products included for Product used for unknown indication: Pfizer vaccine (Dose 2, lot numbers and dates were unknown.), Pfizer vaccine (Dose 1 and lot numbers and dates were unknown.). Past adverse reactions to the above products included No adverse event with Pfizer vaccine and Pfizer vaccine. On 30-Dec-2023, the patient received first dose of INFLUENZA VACCINE INACT SAG 4V (FLUCELVAX QUAD) (Intramuscular use) 1 dosage form. On 30-Dec-2023 at 10:31 AM, the patient received third dose of mRNA-1273.815 (SPIKEVAX 2023-2024) (unknown route) .5 milliliter. On 30-Dec-2023 at 10:32 AM, received fourth dose of mRNA-1273.815 (SPIKEVAX 2023-2024) (unknown route) dosage was changed to .5 milliliter. On 30-Dec-2023, the patient experienced BRAIN FOG (Brain fog), INJECTION SITE PAIN (Muscle Pain at injection site), EXTRA DOSE ADMINISTERED (they accidentally administered 2 doses of Spikevax of 0.5 ml each to an adult patient) and ACCIDENTAL OVERDOSE (they accidentally administered 2 doses of Spikevax of 0.5 ml each to an adult patient). On 31-Dec-2023, the patient experienced INFLUENZA LIKE ILLNESS (Flu like symptoms included: generalized body aches, shivers, sweating). On 30-Dec-2023, BRAIN FOG (Brain fog) had resolved. On 31-Dec-2023, INFLUENZA LIKE ILLNESS (Flu like symptoms included: generalized body aches, shivers, sweating) and INJECTION SITE PAIN (Muscle Pain at injection site) had resolved. At the time of the report, EXTRA DOSE ADMINISTERED (they accidentally administered 2 doses of Spikevax of 0.5 ml each to an adult patient) and ACCIDENTAL OVERDOSE (they accidentally administered 2 doses of Spikevax of 0.5 ml each to an adult patient) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Body temperature: Patient did not have fever as measured with a thermometer.. For mRNA-1273.815 (SPIKEVAX 2023-2024) (Unknown), the reporter considered BRAIN FOG (Brain fog), INFLUENZA LIKE ILLNESS (Flu like symptoms included: generalized body aches, shivers, sweating) and INJECTION SITE PAIN (Muscle Pain at injection site) to be related. No further causality assessments were provided for EXTRA DOSE ADMINISTERED (they accidentally administered 2 doses of Spikevax of 0.5 ml each to an adult patient) and ACCIDENTAL OVERDOSE (they accidentally administered 2 doses of Spikevax of 0.5 ml each to an adult patient). It was reported that patient received other vaccines in the 4 weeks prior to COVID-19 vaccine. On 31-Dec-2023, at 03:00 P.M, the patient experienced flu like symptoms which included: generalized body aches, shivers and sweating. Patient did not have fever as measured with a thermometer. Treatment information was not provided. Most recent FOLLOW-UP information incorporated above includes: On 30-Jan-2024: Significant follow up received, included : reporter details added, patient medical history updated, suspect product details (lot number) updated, co-suspect product details updated, added new events and narrative was updated accordingly.


VAERS ID: 2436453 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: New York  
Vaccinated: 2022-09-08
Onset: 2022-09-09
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2022-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 4 RA / SC
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / UNK RA / SC

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Incorrect route of product administration, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Drug abuse and dependence (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Injection likely given subcutaneously. The person administering the injection squeezed my skin prior to injecting and likely did not reach muscle with the needle. One day later, I have a 2-inch red, swollen area.


VAERS ID: 2260622 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: New York  
Vaccinated: 2021-12-03
Onset: 2021-12-04
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2022-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308458 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Electromyogram, Injection site pain, Pain in extremity, Paraesthesia, Ultrasound Doppler, X-ray
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), 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: levothyroxine 125mcg, multivit, vit D, Cranberry, colase
Current Illness: NA
Preexisting Conditions: obesity
Allergies: latex
Diagnostic Lab Data: MD visit 12/17/21 X-rays to rule out neck injury 12/17/21 Ultrasound of left arm to rule out blood clot 2/4/22 Electromyography 2/11/22
CDC Split Type:

Write-up: Within 24 hrs of injection, I had extreme pain in my left shoulder that lasted a couple of days. Over the last few months, the pain has traveled down my left arm, my fingers have tingled. Currently, my arm aches constantly and the pain is mostly in my elbow.


VAERS ID: 2689928 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: New York  
Vaccinated: 2023-09-22
Onset: 2023-09-01
Submitted: 0000-00-00
Entered: 2023-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 202F23A / UNK RA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 374143 / N/A LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Discomfort, Erythema, Product administered at inappropriate site
SMQs:, Anaphylactic reaction (broad), Drug abuse and dependence (broad), Hypersensitivity (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient reports redness and discomfort due to vaccines being administered too low on the arm. He states that they were injected midway on the arm between shoulder and elbow. He had to visit a doctor for treatment.


VAERS ID: 1952691 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: New York  
Vaccinated: 2021-11-03
Onset: 2021-11-03
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039F21A / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 608485 / 1 RA / 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: 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 administered the 0.25 mL booster dose of Moderna vaccine instead of 0.5 mL.


VAERS ID: 2702677 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: New York  
Vaccinated: 2023-10-10
Onset: 2023-10-20
   Days after vaccination: 10
Submitted: 0000-00-00
Entered: 2023-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 5 AR / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / UNK - / -
RSV: RSV (AREXVY) / GLAXOSMITHKLINE BIOLOGICALS - / 1 AR / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Deep vein thrombosis, Ultrasound scan
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Eliquis
Current Illness:
Preexisting Conditions: Sarcoidosis, protein S deficiency, recurrent PE and DVT, long term anticoagulation, T2DM, HTN, HLD, RBBB, SVT s/p ablation
Allergies:
Diagnostic Lab Data: Ultrasound lower extremity
CDC Split Type:

Write-up: Lower leg DVT


VAERS ID: 1807589 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: New York  
Vaccinated: 2021-10-20
Onset: 2021-10-21
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2021-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / N/A RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Oedema peripheral
SMQs:, Cardiac failure (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: none
Current Illness: none
Preexisting Conditions: none
Allergies: bee stings
Diagnostic Lab Data: none
CDC Split Type:

Write-up: There is an enlarged area under left arm. Area of swelling is approximately 8 cm in diameter. I first noticed the enlargement at 3:00 pm 10/21/2021. This morning at 8:00 am on 10/22/2021 the area of swelling has gotten even larger. Pain down the left arm persists.


VAERS ID: 2700246 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: New York  
Vaccinated: 2023-10-21
Onset: 2023-10-21
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3031894 / 5 LA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370665 / UNK LA / SYR

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

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

Write-up: Swelling at and around site of injection.


VAERS ID: 1876449 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Male  
Location: New York  
Vaccinated: 2021-11-15
Onset: 2021-11-15
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308491 / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, Malaise, Pallor, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: unknwon
Allergies: unknown
Diagnostic Lab Data: none- pt has an appointment with pediatrician coming up soon
CDC Split Type:

Write-up: Immediately after administering both vaccines, patient passed out for few seconds, Once he woke up, he did not feel well and started vomiting. He was very pale. Patient was given some orange juice, which seemed to help. Patient stayed for observation for over 15 minutes and recovered well. Patient did not report any of the following signs ( wheezing, sob, swelling , hives). Per patient parent , patient has a history of reacting in similar way to pain before.


VAERS ID: 2076652 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: New York  
Vaccinated: 2022-01-31
Onset: 2022-01-31
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-01-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ6369 / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308430 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: cephalexin 500 mg-1c po qid diazepam 5mg -1t po bid prn doxycycline mono 100 mg - 1c po bid propranolol er 60 mg- 1c po qd lisinopril 20 mg- 1t po qd valacyclovir 500- 1t po qd gabapentin 800 mg-1t po q8h synthroid 100 mcg-1t po qd pantop
Current Illness: unknown-on antibiotics
Preexisting Conditions: hypothyroidism hypertension anxiety bulging back disc-per patient sciatica-per patient
Allergies: latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: potential lightheadedness


VAERS ID: 2716098 (history)  
Form: Version 1.0  
Age: 1.25  
Sex: Female  
Location: New York  
Vaccinated: 2023-10-24
Onset: 2023-10-25
   Days after vaccination: 1
Submitted: 2023-10-25
   Days after onset: 0
Entered: 2023-11-20
   Days after submission: 26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AU5558B / UNK LA / IM
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR UJ849AA / UNK RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 374408 / UNK RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. X017487 / UNK LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Erythema, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Premarin vaginal cream
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: No
CDC Split Type:

Write-up: Redness and swelling (no warmth or tenderness) after flu and pentacel


VAERS ID: 2040220 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Ohio  
Vaccinated: 2022-01-03
Onset: 2022-01-03
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-01-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD7218 / 3 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308497 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Loss of consciousness, Nausea, Tremor
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), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Passed out after 1st Pfizer vaccine at a different facility, exact date unknown.
Other Medications: Escitalopram 20mg
Current Illness:
Preexisting Conditions: Anxiety disorder
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed out within minutes of receiving Pfizer Covid booster and flu immunization. Patient became nauseous and light headed and then started to shake. She quickly became unconscious and was lowered to the ground without incident. Patient regained consciousness within 30 seconds. Patient''s feet were elevated and she remained in a lying position until nausea and lightheadedness subsided. Patient was offered lemonade once she sat up. She was monitored in the store for 45 minutes and fully recovered. Patient denied the need to call 911. Patient has a history of fainting and did so with her 1st COVID vaccine as well.


VAERS ID: 1943492 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Ohio  
Vaccinated: 2021-12-13
Onset: 2021-12-13
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067H21A / 1 RA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308523 / 1 LA / IM

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

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

Write-up: Patient was given Moderna 0.5ml instead of 0.25ml for booster. His initial COVID vaccine was Johnson & Johnson/Jannsen given March 2021.


VAERS ID: 1804649 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Ohio  
Vaccinated: 2021-10-21
Onset: 2021-10-21
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308432 / 1 RA / IM

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

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

Write-up: Patient was given both vaccines and told to wait in waiting room. The patient felt dizzy and light headed, and may have slightly passed out. The patient told the pharmacist she had skipped breakfast and may have low blood sugar. The pharmacist gave her a bottle of water and a glucose tablet.


VAERS ID: 1822405 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Ohio  
Vaccinated: 2021-10-27
Onset: 2021-10-27
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 2 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308473 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypotonia, Unresponsive to stimuli
SMQs:, Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Patient received two vaccines in the same arm. After receiving the second shot (flu), patient began to slide out of the chair. Pharmacist caught her and she did not fall or hit anything. She was unresponsive to a verbal question but awakened upon shaking (jumped slightly as if waking up from sleep). She said she remembered feeling the second shot but did not recall falling or being caught by the pharmacist. Patient felt otherwise fine and left after 15 minutes of observation.


VAERS ID: 2722522 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Ohio  
Vaccinated: 2023-12-09
Onset: 2023-12-09
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3030535 / N/A LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370659 / N/A RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Immunisation reaction, Loss of consciousness, Throat tightness
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Amoxicillin
Diagnostic Lab Data: none
CDC Split Type:

Write-up: The patient was given both the Moderna Spikevax 2023 and Flucelvax Quad in the same visit. He was first given the covid vaccine in the left deltoid and then given the flu shot in the right deltoid. A few seconds after getting the second vaccine, the patient began to lose consciousness and his airways began to close and he was gasping for air. After administering a 0.3 mg epinephrine pen injector, the patient began breathing more normally and he regained consciousness and was aware of his surroundings. While the patient was having the reaction, EMS was contacted by another pharmacy employee. We stayed with the patient and monitored his status until EMS arrived.


VAERS ID: 2062776 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Ohio  
Vaccinated: 2021-12-28
Onset: 2021-12-28
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0810 / 3 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308475 / N/A LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Shortly after the administration of both vaccines patient started to get lightheaded. She stated that she sometimes gets like this after vaccines. She laid down on the floor, drank some water and was able to eat some fruit snacks. Her symptoms resolved in 15 minutes.


VAERS ID: 2147571 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Ohio  
Vaccinated: 2022-02-11
Onset: 2022-02-24
   Days after vaccination: 13
Submitted: 0000-00-00
Entered: 2022-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042J21A / 3 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308490 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2022-02-24
   Days after onset: 0
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: flucelvax quadrivalent
Current Illness:
Preexisting Conditions:
Allergies: no known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: I was informed on 2/24/22 at 9:46pm by patient''s son who I work with via text that patient had a heart attack and patient left for the hospital on an ambulance. I was informed via text that patient died on 2/24/22 at 10:53pm. Patient''s son came in to the pharmacy on 2/26/22 around 5pm and told me that they are looking in to if Moderna was related to patient''s cause of death.


VAERS ID: 2034863 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Ohio  
Vaccinated: 2022-01-07
Onset: 2022-01-07
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041J21A / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308429 / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Sexual dysfunction (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: n/a
CDC Split Type:

Write-up: 30 min after vaccine administration pt returned to pharmacy counter and said her facial cheeks felt numb. no other side effects.


VAERS ID: 2706530 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Ohio  
Vaccinated: 2023-10-24
Onset: 2023-10-26
   Days after vaccination: 2
Submitted: 0000-00-00
Entered: 2023-10-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / N/A RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / N/A RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Pain in extremity, Peripheral swelling, Pruritus
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), 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flax Seed Oil, Tumeric and Multi-vitamin
Current Illness: none
Preexisting Conditions: arthritis
Allergies: Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: My paperwork for the Covid shot says Spikevax 12+ (Covid) 23-24. NDC 80777-0102-96. (I can''t find that option above) My arm was quite swollen, painful red and very itchy almost 2 days AFTER I got my shots. I did get my flu shot in the same arm on the same day but the fact that it took that to develop an issue and that the condition, though relatively minor, also lasted for almost a week. I am glad that this was not life threatening but I''d never had a reaction of this type before and I''ve had all of my recommended doses through the years.


VAERS ID: 2692421 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Ohio  
Vaccinated: 2023-10-03
Onset: 2023-10-03
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HD9835 / UNK LA / SC
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944481 / 1 LA / SC

Administered by: Pharmacy       Purchased by: ?
Symptoms: Posture abnormal, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (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: unknown
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt fainted about 2 minutes after the completion of both vaccinations. Talking with family, father looked over and pt''s head was slumped over. We moved patient to bench with head elevated and she immediately recovered consciousness. Asked current event questions and he responded immediately and correctly. Patient sat around for 5 minutes and father decided to take her home.


VAERS ID: 2717787 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Ohio  
Vaccinated: 2023-11-10
Onset: 2023-11-10
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3030535 / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944446 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pyrexia, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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: N/A
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient had a fever the night of his vaccination (Friday night) and was fine the next day but on Tuesday he developed a very itchy rash. He went to the doctor wednesday and was prescribed cetirizine


VAERS ID: 2132278 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Ohio  
Vaccinated: 2022-02-14
Onset: 2022-02-21
   Days after vaccination: 7
Submitted: 0000-00-00
Entered: 2022-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ6369 / 2 - / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308442 / N/A - / 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:
Current Illness:
Preexisting Conditions: asthma
Allergies: nka
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received expired vaccine. DH and Pfizer recommend revaccination. Patient was contacted to schedule an appointment. Patient scheduled appointment.


VAERS ID: 2732049 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Ohio  
Vaccinated: 2024-01-10
Onset: 2024-01-11
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2024-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HM7006 / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944445 / UNK LA / IM

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

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

Write-up: Rash on hands. Irritation, itchiness, and swelling of hands, mainly right hand.


VAERS ID: 2338972 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Oklahoma  
Vaccinated: 2022-01-28
Onset: 2022-01-28
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3198 / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. P100360866 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Alcohol abuse, Alcoholism, COVID-19, Condition aggravated, Depression, Diabetes mellitus, Gastritis alcoholic, Nausea, Pancreatitis chronic, SARS-CoV-2 test, Vaccine breakthrough infection, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific inflammation (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (narrow), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

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? Yes, 3 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Pancreatitis chronic alcoholism alcoholic gastritis anxiety depression DM HTN GERD
Allergies: Amoxicillin Codeine Penicillin Sulfa
Diagnostic Lab Data: 6/21/22: Abbott ID now covid test
CDC Split Type:

Write-up: Breakthrough covid case; Pt presented to ER with c/o abdominal pain, nausea and vomiting. Hx of Pfizer vaccine x 3. Hospitalized at Hospital x 3 days. DX alcoholic gastritis, alcohol abuse and dependence, chronic pancreatitis, depression, DM, and covid 19. No other covid symptoms at this time. Patient hospitalized in May for pancreatitis then DC to rehab.


VAERS ID: 2104742 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Oklahoma  
Vaccinated: 2022-01-26
Onset: 2022-01-26
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK9729 / 3 - / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308453 / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Attempted to contact patient 3 times by phone. No return call
Current Illness: Attempted to contact patient 3 times by phone. No return call
Preexisting Conditions: Attempted to contact patient 3 times by phone. No return call
Allergies: Attempted to contact patient 3 times by phone. No return call
Diagnostic Lab Data:
CDC Split Type:

Write-up: Gave Pfizer Booster one month early. Contacted Pfizer- stated no additional dose needed. Contacted Patient 01/27/2022- patient stated, no issues or severe reactions.


VAERS ID: 1815178 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Oklahoma  
Vaccinated: 2021-10-15
Onset: 2021-10-15
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 3 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 309616 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Extra dose administered, Hypoaesthesia, Inappropriate schedule of product administration, Paraesthesia, Pharyngeal hypoaesthesia, Pharyngeal paraesthesia, Rash
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: patient reported that she had developed tingling in the back of her throat within 5-10 minutes of prior COVID-19 vaccines but th
Other Medications: none
Current Illness: none reported
Preexisting Conditions: none reported
Allergies: latex - rash
Diagnostic Lab Data:
CDC Split Type:

Write-up: ? Patient was vaccinated with booster dose of Pfizer COVID-19 vaccine on 10/15/21 at 13:27 and Patient had what appeared to be a hypersensitivity reaction within 10 minutes of receiving the COVID-19 (Lot: EW0150; Exp 10/31/2021) and flu (Lot: 309616, Exp: 6/30/2022) vaccines. ? She reported feeling numbness and tingling in the back of her throat, bilateral numbness and tingling on her arms and legs. She also developed a rash behind her ear (she denied scratching or touching the area). Her O2 saturation was 98% and pulse was 89. I called our Medical Director and followed the clinic protocol to administer diphenhydramine 50 mg IM. Patient was monitored for 1 hour. By the end of the monitoring period, her symptoms had resolved, pulse ox remained stable (97%) and pulse was 86. I let her go home with a coworker. ? Patient answered no to all COVID-19 vaccine screening questions and did not divulge that she had reactions to dose 1 and 2. However, when I probed the patient for more information while treating this reaction, the patient reported that she had developed tingling in the back of her throat within 5-10 minutes of prior COVID-19 vaccines but the symptoms resolved without interventions. ? Other allergies: latex that cause rash ? Patient is not on any home medications


VAERS ID: 2339209 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Oklahoma  
Vaccinated: 2021-10-29
Onset: 2022-06-24
   Days after vaccination: 238
Submitted: 0000-00-00
Entered: 2022-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. P10035853 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Pain, Rhinorrhoea, SARS-CoV-2 test, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data: 6/24/22: Cepheid covid test.
CDC Split Type:

Write-up: Breakthrough covid case; Pt presented to ER on 6/24/22 with c/o sinus drainage, cough, body aches. Hx of Pfizer vaccine x 3 doses. Pt recently traveled. DC home.


VAERS ID: 2724945 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Oklahoma  
Vaccinated: 2023-12-18
Onset: 2023-12-18
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HG4589 / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 374408 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Disorientation, Injection site haemorrhage, Loss of consciousness, Malaise, Nausea
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Patient was bleeding at the injection site. As I was cleaning the site she stated that she didn''t feel well. I checked to make sure she wasn''t having trouble breathing. No signs of allergic reaction. After a minute or so she passed out and slid down in her chair. She regained consciousness quickly but seemed disoriented and said she felt nauseated. She was given water and a cold cloth. She was monitored in the immunization room for about 5-10 minutes. At that time she said she felt better and was able to stand and walk. She then left with her parent and was advised to report any further concerns.


VAERS ID: 2708171 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Oklahoma  
Vaccinated: 2023-10-23
Onset: 2023-10-23
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AU5551B / 2 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370647 / N/A RA / IM

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

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

Write-up: After vaccines were administered, it was discovered that the incorrect Moderna Covid vaccine was given. The 13-year-old child was inadvertently given the 6mo-12yr formulation. No adverse side events were reported.


VAERS ID: 2339216 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Oklahoma  
Vaccinated: 2021-12-07
Onset: 2022-06-25
   Days after vaccination: 200
Submitted: 0000-00-00
Entered: 2022-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012H21B / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. P100367237 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Cough, Dyspnoea, Influenza virus test, Nasal congestion, Pyrexia, SARS-CoV-2 test, Streptococcus test, Urine analysis, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Fish oil motrin NSAID tomatoes
Diagnostic Lab Data: 6/25/22: influenza, strep A, Abbott ID now covid test, UA
CDC Split Type:

Write-up: Breakthrough covid case. Pt presented to ER on 6/25/22 with c/o nasal congestion, loss of smell and taste, cough, sob and fever. Pt test positive in 1/2022. Hx of Moderna vaccine x 3 doses. Prescribed Paxlovid. DC home.


VAERS ID: 2698777 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Oregon  
Vaccinated: 2023-10-16
Onset: 2023-10-17
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3030498 / 1 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370664 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Hot flush, Hyperhidrosis, Night sweats, Pyrexia, Sleep disorder
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lexapro Wellbutrin Magnesium Zyrtec Women''s Daily Vitamin Occasionally Propranolol
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: I have had hot flashes and excessive night sweating for 4 consecutive nights since receiving the vaccine. I have had to change my clothes in the middle of the night 2x, once normally around 2 am and once around 5am. I have not had a fever since after Tuesday, which was 24 hours after I received the vaccine


VAERS ID: 2716021 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Oregon  
Vaccinated: 2023-11-17
Onset: 2023-11-17
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 4 LA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / N/A LA / SYR

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

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

Write-up: Enlarged red mark and swelling at injection site. Lump in armpit on the same arm


VAERS ID: 2701011 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Oregon  
Vaccinated: 2023-10-17
Onset: 2023-10-17
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AU5552B / 1 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370659 / 1 RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS 7MH39 / 1 RA / IM

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? 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: NKDA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Administered SARS-COV-2 (COVID) 2023-24 (6MO-11YR)(MODERNA), MRNA. The patient may have received 0.5mL dose. The manufacture provided 0.5mL per vial instated of 0.25mL/ vial.


VAERS ID: 1955510 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Oregon  
Vaccinated: 2021-12-11
Onset: 2021-12-11
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H21A / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 309616 / 1 LA / IM

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

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

Write-up: pt received full moderna dose and not booster dose, no adverse reaction was reported


VAERS ID: 2465682 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Oregon  
Vaccinated: 2022-09-13
Onset: 2022-09-25
   Days after vaccination: 12
Submitted: 0000-00-00
Entered: 2022-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -
COVID19-2: COVID19 (COVID19 (PFIZER-BIONTECH BIVALENT)) / PFIZER/BIONTECH GH9702 / 4 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 942390 / N/A RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arrhythmia, Arteriogram coronary normal, Atrial tachycardia, Blood magnesium decreased, Blood potassium decreased, Blood test, Cardiac ablation, Cardiac electrophysiologic study abnormal, Cardioversion, Dyspnoea, Echocardiogram abnormal, Ejection fraction, Heart rate increased, Loss of consciousness, Prosthetic cardiac valve regurgitation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (narrow), Noninfectious myocarditis/pericarditis (broad)

Life Threatening? Yes
Birth Defect? Yes
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Entresto 49/51mg x2 daily Metoprolol Succinate 25mg x2 daily Eplerenone 25mg x1 daily Penicillin 500mg x2 daily Usodiol 250mg x2 daily Melatonin 5mg x1 daily Bariatric Advantage All-in-one multivitamin x4 daily Chamomile Tea x1
Current Illness: Post roux-en-y bariatric surgery on 8/18/22
Preexisting Conditions: Heart Failure Bicuspid Aortic valve (was replaced in 2018 and again in 2020) Aortic Valve Replacement x2 Mitral Valve Repair Cardiac Fistula Repair Ascending Aortic Aneurysm High Blood Pressure Obesity ADHD
Allergies: Nickel (metal) - causes skin rash
Diagnostic Lab Data: 9/25-9/28/22 Various blood tests - was found to be slightly low in magnesium and potassium post tachycardia episode. 9/26/22 - Angiogram - found to be clear of blockages 9/27/22 - Cardiac Electrophysiology study - was able to reproduce arrhythmia, received successful cardiac ablation.
CDC Split Type:

Write-up: On 9/25/22 Experienced loss of consciousness while out on a hike, and upon regaining consciousness I realized my heart rate was extremely fast and I was struggling to breathe. Called 911, was found to have a resting heart rate of ~300bpm. Was air lifted to hospital. Received cardioversion which successfully restored normal sinus rhythm. Received an angiogram with clear results. Received echocardiogram showing moderate paravalvular leak and EF of ~30% (EF thought to be a result of cardioversion) Received electrophysiology study which was able to reproduce atrial tachycardia, then received cardiac ablation, reported to be successful in preventing reporduction of atrial tachycardia. Was released on 9/28/22


VAERS ID: 2701170 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Female  
Location: Oregon  
Vaccinated: 2023-10-12
Onset: 2023-10-17
   Days after vaccination: 5
Submitted: 0000-00-00
Entered: 2023-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AU5552B / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370659 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Manufacturing issue
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: N/A
Current Illness: N/A
Preexisting Conditions: Hemolytic anemia
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Administered SARS-COV-2 (COVID) 2023-24 (6MO-11YR)(MODERNA), MRNA, 0.25 ML DOSE. The patient may have received 0.5mL. The manufacture provided 0.5mL per vial instead of 0.25mL/ Vial.


VAERS ID: 2701179 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Female  
Location: Oregon  
Vaccinated: 2023-10-16
Onset: 2023-10-17
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AU5552B / 1 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370659 / 1 RA / IM

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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: fluoride (sodium) chewable 0.5 mg elemental oral tablet
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Administered SARS-COV-2 (COVID) 2023-24 (6MO-11YR)(MODERNA), MRNA, 0.25 ML DOSE. The patient may have received 0.5mLper Vials instead of 0.25 mL/ vial.


VAERS ID: 1955314 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Oregon  
Vaccinated: 2021-12-11
Onset: 2021-12-11
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H21A / 3 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. IN202122 / 1 - / IM

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

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

Write-up: Pt was given full dose instead of half booster dose, no symptoms reported


VAERS ID: 2701525 (history)  
Form: Version 2.0  
Age: 3.0  
Sex: Male  
Location: Oregon  
Vaccinated: 2023-10-11
Onset: 2023-10-17
   Days after vaccination: 6
Submitted: 0000-00-00
Entered: 2023-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AU5552B / 1 LL / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370659 / 1 LL / IM

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? 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: NKDA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Administered SARS-COV-2 (COVID) 2023-24 (6MO-11YR)(MODERNA), MRNA, 0.25 ML DOSE. The patient may have received 0.5mL per vial instead of 0.25mL / dose. The manufacture provided 0.5mL per single vial.


VAERS ID: 1955337 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Oregon  
Vaccinated: 2021-12-11
Onset: 2021-12-11
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H21A / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 309616 / 1 LA / IM

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

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

Write-up: Patient received full dose instead of booster dose. No adverse reaction reported.


VAERS ID: 2701533 (history)  
Form: Version 2.0  
Age: 0.75  
Sex: Female  
Location: Oregon  
Vaccinated: 2023-10-11
Onset: 2023-10-17
   Days after vaccination: 6
Submitted: 0000-00-00
Entered: 2023-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AU5552B / 1 LL / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370664 / 1 RL / IM

Administered by: Private       Purchased by: ?
Symptoms: Manufacturing issue
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: albuterol 90 mcg/actuation inhalation HFA aerosol inhaler fluticasone propionate (FLOVENT HFA) 44 mcg/actuation inhalation HFA aerosol inhaler fluoride (sodium) 0.5 mg/mL oral drops
Current Illness: Bronchiolitis Atopic dermatitis, unspecified type
Preexisting Conditions: Acquired plagiocephaly Torticollis, acquired Bronchiolitis Atopic dermatitis, unspecified type
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Administered SARS-COV-2 (COVID) 2023-24 (6MO-11YR)(MODERNA), MRNA, 0.25 ML DOSE. The patient may have received 0.5mL per dose instead of 0.25mL per dose. The manufacture provided 0.5mL per single dose vial.


VAERS ID: 1942298 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Oregon  
Vaccinated: 2021-12-09
Onset: 2021-12-09
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045J21A / 3 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308482 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Dizziness, Immediate post-injection reaction
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow)

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

Write-up: Client received Covid 19 Moderna vaccination then received her flu vaccination Flucelvax Quadrivalent immediately after. She complained of feeling dizzy immediately after the flu vaccination. She was placed in a supine postion with her feet up and reported relief. VS stable throughout. 4:15 PM HR 68, RR 18, BP 130/70, 4:20 HR72 RR 16, BP 132/80, 4:45PM HR 60, RR 16, BP 124/76. 4:45 PM client was placed in a sitting position with no symptoms. Husband was present. 5:50 PM discharged with husband. Denies any further dizziness. Husband drove her home.


VAERS ID: 2701562 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Male  
Location: Oregon  
Vaccinated: 2023-10-10
Onset: 2023-10-17
   Days after vaccination: 7
Submitted: 0000-00-00
Entered: 2023-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AU5552B / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370664 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Manufacturing issue
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: methylphenidate ER 24 hour 18 mg oral tablet extended release
Current Illness: N/A
Preexisting Conditions: Seizure disorder Attention deficit hyperactivity disorder (ADHD), combined type
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Administered SARS-COV-2 (COVID) 2023-24 (6MO-11YR)(MODERNA), MRNA, 0.25 ML DOSE The patient may have received 0.5mL per dose instead of 0.25mL/ dose. The manufacture provided 0.5mL per single vial.


VAERS ID: 2701583 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Male  
Location: Oregon  
Vaccinated: 2023-10-11
Onset: 2023-10-17
   Days after vaccination: 6
Submitted: 0000-00-00
Entered: 2023-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AU5552B / 1 LL / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370664 / 1 RL / IM

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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: FLUORIDE (SODIUM) 1 mg elemental oral tablet, chewable
Current Illness: N/A
Preexisting Conditions: Ankyloglossia
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Administered SARS-COV-2 (COVID) 2023-24 (6MO-11YR)(MODERNA), MRNA, 0.25 ML DOSE. The patient may have received 0.5mL per dose instead of 0.25mL per dose. The manufacture provided 0.5 mL per single dose vial instead of 0.25mL.


VAERS ID: 2701586 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Male  
Location: Oregon  
Vaccinated: 2023-10-11
Onset: 2023-10-17
   Days after vaccination: 6
Submitted: 0000-00-00
Entered: 2023-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AU5552B / 1 LL / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370664 / 1 RL / IM

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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: FLUORIDE (SODIUM) CHEWABLE 0.5 mg elemental oral tablet, CHILDREN''S CHEWABLE VITAMIN ORAL
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Administered SARS-COV-2 (COVID) 2023-24 (6MO-11YR)(MODERNA), MRNA, 0.25 ML DOSE. The patient may have received 0.5mL instead of 0.25mL per dose. The manufacture provided 0.5mL per single dose vial.


VAERS ID: 2701596 (history)  
Form: Version 2.0  
Age: 3.0  
Sex: Female  
Location: Oregon  
Vaccinated: 2023-10-10
Onset: 2023-10-17
   Days after vaccination: 7
Submitted: 0000-00-00
Entered: 2023-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AU5552B / 1 LL / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370664 / 1 LL / IM

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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: Viral URI with cough
Preexisting Conditions: Hemangioma of skin
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Administered SARS-COV-2 (COVID) 2023-24 (6MO-11YR)(MODERNA), MRNA, 0.25 ML DOSE. The patient may have recieved 0.5mL per dose insted of 0.25mL. The manufacture provided 0.5mL per single dose vial.


VAERS ID: 2701604 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Female  
Location: Oregon  
Vaccinated: 2023-10-13
Onset: 2023-10-17
   Days after vaccination: 4
Submitted: 0000-00-00
Entered: 2023-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AU5552B / 1 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370659 / 1 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. W011624 / 1 RA / SC

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: loratadine ORAL
Current Illness: Cough, unspecified type
Preexisting Conditions: N/A
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Administered SARS-COV-2 (COVID) 2023-24 (6MO-11YR)(MODERNA), MRNA, 0.25 ML DOSE. The patient may have received 0.5mL instead of 0.25mL / dose. The manufacture provided 0.5mL single dose vial and noted contained 0.25mL


VAERS ID: 2365962 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Oregon  
Vaccinated: 2022-06-15
Onset: 2022-06-16
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2022-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054A22A / 4 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308483 / N/A RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Anxiety, Blister, Erythema, Speech disorder, Tachypnoea, Urticaria
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (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? Yes, ? days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen; amlodipine; aspirin; atorvastatin; buspirone; CALMOSEPTINE oint; cetirizine; cyanocobalamin; diphenhydramine; famotidine; furosemide; hydrocortisone; loratadine; multivitamin; potassium chl ER; prednisone; sertraline; Soothe
Current Illness: See attached
Preexisting Conditions: Anxiety; Hypertension; Constipation; Anemia; Urinary Retention; Delirium; Presence of Prosthetic Heart Valve; Varicose Veins; Vitamin D Deficiency; Femur Fracture; Dysmorphism; Spinal Stenosis; Vitamin B12 Deficiency Anemia; History of Malignant Neoplasm of Breast; Pathological Fracture Due To Osteoporosis
Allergies: Penicillin; Adhesive Tape; Latex; plastic Tape; Citruses and Tomato
Diagnostic Lab Data: See attached
CDC Split Type:

Write-up: 06/16/2022 RN NOTE: Summoned to rsdt apartment this afternoon at approximately 1545pm for possible symptoms of allergic reaction. Observation of rsdt in apartment revealed copious coalescing areas of erythema, blistering, and hives accompanied by tachypnea d/t anxiety with difficulty speaking. No existing orders for Benadryl or EPIPEN. 911 summoned. IV line established by EMTs who administered Benadryl bolus followed by bag of fluids. Rsdt transferred to hospital for further evaluation and management. Dtr notified of all of above and expressed understanding and will follow up with hospital this evening. Rsdt received COVID and flu vaccines 06.15.2022 at approximately 1400pm and received 1/2 honey crisp apple to snack on following vaccines while being directly monitored for adverse reaction for 30 minutes following vaccines. Rsdt stated to EMTs that she began experiencing symptoms "this morning" though rsdt had received supportive care this morning and had attended breakfast and lunch without evidence of the same noted by staff until this afternoon. Extent of erythema, blisters, hives became more extensive from the time when RN initially observed rsdt and when rsdt left community with EMTs enroute for hospital despite bolus of IV Benadryl. Placing rsdt on leave. Awaiting further information from hospital.


VAERS ID: 2558275 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated: 2023-01-10
Onset: 2023-01-11
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FP7140 / 5 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 353556 / N/A 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received incorrect vaccine. Original formula was administered instead of the bivalent booster.


VAERS ID: 2695383 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated: 2023-10-06
Onset: 2023-10-06
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HG4628 / 5 RA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 94450 / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pain in extremity, Pallor, Peripheral coldness, Skin discolouration
SMQs:, Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pfizer COVID-19 bivalent vaccine caused a swollen lymph node on the side of the reaction administered 9/21/22 age 25
Other Medications: Xyrem, spironolactone, nortriptyline, effexor, concerta, omeprazole, pepcid, feverfew, CoQ10, B12, B2, Mg oxide, D3, migrelief
Current Illness:
Preexisting Conditions: Migraine, narcolepsy, IBS, gastroparesis, PCOS, obstructive sleep apnea, autism spectrum disorder, ADHD
Allergies:
Diagnostic Lab Data: The pharmacist used a thermometer for a surface temperature and compared it to his skin at the same regions and I was a lot colder than he was by about 15-20+?F in all regions. Many temperatures on the surface were too low to even be read by the thermometer, some were 66?F.
CDC Split Type:

Write-up: At 12 PM I got my annual flu vaccine in my left arm at 11:50 AM and only symptom was injection site soreneds prior to COVID-19 Comirnaty vaccination At 3:30 PM, I got my COVID-19 Comirnaty vaccine and before I even left the facility at 4:00 I became cold to the touch (hands, fingers, wrists arms, toes, feet, ears, nose, lower legs, around the eyes, cheeks) and skin turned pale and a purple hue in these regions. It has almost been a week and I am still cold to the touch in these areas just 30 min after vaccination and a sore arm on that side too.


VAERS ID: 2726330 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated: 2023-12-17
Onset: 2023-12-17
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AU5552B / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370656 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Feeling hot, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: unknown
Current Illness: no
Preexisting Conditions: no
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt became nauseous post injection within 10-15minutes. parents caught her prior to falling . Alerted her and continued to talk to her. Patient stated she was hot and vomited. Cold compress was place on head until ambulance arrived. Assessment done by paramedics and patient was given permission to go home.


VAERS ID: 2723024 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: Pennsylvania  
Vaccinated: 2023-11-15
Onset: 0000-00-00
Submitted: 2023-11-20
Entered: 2023-12-11
   Days after submission: 21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 203G23A / UNK LA / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944497 / UNK LA / -

Administered by: Other       Purchased by: Public
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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received a vaccine that had been sitting at room temperature for 5.5 days.


VAERS ID: 2720987 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated: 2023-12-03
Onset: 2023-12-05
   Days after vaccination: 2
Submitted: 0000-00-00
Entered: 2023-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 8058877 / 4 RA / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944447 / UNK RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Rash, Rash pruritic
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: Birth control, antidepressant
Current Illness:
Preexisting Conditions:
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Itchy rash all over legs, buttocks, and around elbow on left arm


VAERS ID: 2477354 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated: 2022-10-01
Onset: 2022-10-01
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL2757 / 3 RA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 942432 / UNK LA / IM

Administered by: Pharmacy       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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Vaccine was given 1 day past expiration date. Did not realize it was short dated when rec''d so we were going by the 10 week BUD. Patient did not experience any side effects.


VAERS ID: 1917898 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated: 2021-12-02
Onset: 2021-12-02
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308474 / UNK RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cough, Loss of consciousness, Retching, Seizure, Skin warm, 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), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: The patient received Pfizer vaccine in his left arm, then we reivewed his administration form about his flu shot and I gave the Flucelvax vaccine in his right arm. As soon as I pulled the needle out and reached for the band aid, he lost conciousness. A caretaker of the center called him by name many times and he was unresponsive for 15-20 seconds. She said he was having a seizure. She said he has had them in the past, but it has been a very long time since his last eipsode. He regained conciousness after 15-20 seconds and he was warm to the touch. He cough several times as if he was going to vomit, but he never did. We called 911. The patient insisted that he was fine and he did not want to go to the ER and did not want to lay down. Paramedics came and evaluated the patient. His BP was 110/70, Pulse of 76, and had an oxygen sat of 97. They waited until about 1:10 and then they left when they felt he was stable. The patient left with a caretaker.


VAERS ID: 1905660 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated: 2021-10-29
Onset: 2021-11-10
   Days after vaccination: 12
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Pruritus, 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: spironolactone, probiotics
Current Illness: none
Preexisting Conditions: none
Allergies: sulfa drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: 12 days after vaccination, I developed full body itchiness that when scratched turns into hives and a large surface area of the skin turns red. The itchy areas travel but is usually located on my upper body: scalp, neck, ears (outer and inner), chest, stomach, palms of hands and feet. The itchiness and redness/rash is relieved with antihistamines (Benadryl and Claritin have been taken) but returns if none are taken. It has been like this for almost 3 weeks now. I have an appointment with an allergist at the end of this week. I have ruled out any new environmental allergens as potential sources for itchiness.


VAERS ID: 2548978 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated: 2022-10-12
Onset: 2022-10-12
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AR6965B / UNK RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. UT7682LA / 1 LA / IM

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? 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: No adverse reaction. Patient given Moderna monovalent booster instead of Moderna bivalent booster. Patient notified.


VAERS ID: 2529486 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated: 2022-12-12
Onset: 2022-12-12
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-12-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 074B22A / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 350172 / N/A RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Consciousness fluctuating, Feeling abnormal, Gaze palsy, Hypoacusis, Hypotension, Laboratory test, Pallor, Seizure
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hearing impairment (narrow), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), 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: Unknown
Current Illness: None specified
Preexisting Conditions: None
Allergies: None specified
Diagnostic Lab Data:
CDC Split Type:

Write-up: Gave patient her 2 shots (flu and Moderna). I vaccinated her mom with 3 vaccines while patient was still sitting. She said she does not feel good. Next moment she had what looked like a seizure and was very pale and her eye rolled back in her head. I had to hold her to prevent her from slipping off the chair. She was in and out of consciousness and said she cannot hear us well. Since the fainting spells kept recurring, the Mom agreed that we call 911. The EMT''s came and took her vitals. Her blood pressure was very low. They got her on the stretcher and took her to the nearest local hospital. I checked in with the patient around 7.30pm and she was home and feeling 100%. She said they just gave her some fluids and ran some tests, but all is good.


VAERS ID: 2590263 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated: 2022-12-06
Onset: 2022-12-27
   Days after vaccination: 21
Submitted: 0000-00-00
Entered: 2023-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH GJ6738 / 4 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 942444 / N/A RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Computerised tomogram normal, Dyskinesia, Magnetic resonance imaging normal, Tic
SMQs:, Neuroleptic malignant syndrome (broad), Dyskinesia (narrow), Dystonia (broad), Noninfectious encephalopathy/delirium (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: possibly a cold in December
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: CT Scan - December 27th - negative MRI - January 5th - negative
CDC Split Type:

Write-up: Precisely 3 weeks post-administration of vaccines a TIC disorder developed. An uncontrollable head movement developed. Continues as of March 2, 2023, but with varying degrees of frequency and unsuccessful medical management.


VAERS ID: 2187500 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated: 2022-02-25
Onset: 2022-02-25
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3209 / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308485 / N/A RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event, 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: UNKNOWN
Current Illness: N/A
Preexisting Conditions: UNKNOWN
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: PFIZER COVID-19 VACCINE WAS ADMINISTERED AFTER THE 30 DAY PERIOD THAT THE VACCINE IS ALLOWED TO BE STORED IN THE REFRIGERATOR. PATIENT DID NOT REPORT ANY ADVERSE EVENT TO THE VACCINE THAT HE RECEIVED.


VAERS ID: 2685625 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated: 2023-09-21
Onset: 2023-09-22
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HD9835 / 1 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 371562 / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pruritus, Injection site vesicles
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Also received Flucelvax at the same time. Not taken at the same time: Patient takes Pregabalin, Gabapentin, Fluoxetine, Albuterol
Current Illness: None
Preexisting Conditions: Asthma, Seizures, depression
Allergies: Shellfish, Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received Comirnaty but form won''t let me move on without putting this in. Patient developed 6 full blisters a day after vaccine right where vaccine was given on right arm. No other Symptoms. They became itchy and kept refilling the following day. Was instructed to take Benadryl and put on topical steroids.


VAERS ID: 2684470 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated: 2023-09-19
Onset: 2023-09-20
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3030372 / 6 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Malaise, Nausea, Pain, 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: Took morning (daily) meds at 8:00/took nothing immediately prior to vaccination
Current Illness: summer cold ended around 16SEP2023
Preexisting Conditions: T2DM
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Body aches/chills started around 7:00 on 20SEP2023. Nausea hit at about 9:00 and then vomiting shortly after. Had taken 2 tylenol but they came back up. After vomiting, took 400mg ibuprofen. Today (21SEP2023) only nausea/vomiting remain. Vomited at about 8:15 this morning. Feeling blah (malaise) now but chills and body aches are gone. Took 400mg ibuprofen this morning.


VAERS ID: 1997104 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated: 2021-12-22
Onset: 2021-12-22
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-01-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA NO BATCH NUMBER / UNK LA / OT
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 309621 / UNK LA / OT

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product administration error, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Medication errors (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: Hypoglycemia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USSEQIRUS202107742

Write-up: Passed out/fainted; The patient received Flucelvax Quadrivalent and Spikevax on the same day, both in left deltoid; This spontaneous case was received on 22-Dec-2021 from a pharmacist (reference number: SEQW21-06337) and concerned a 29-year-old, male patient. The patient''s concurrent condition included hypoglycaemia before injections (the patient had not eaten all day before receiving both vaccines). The was not taking any concomitant medications. On 22-Dec-2021, the patient was vaccinated with Flucelvax Quadrivalent (influenza vaccine, subunit influenza virus vaccine polyvalent; dose: 0.5 ml, route of administration: intramuscular and anatomical location: left deltoid) for influenza prophylaxis The batch number reported was 309621 and expiry date 30-Jun-2022. On the same day, the patient was vaccinated with a non-company, co-suspect Spikevax (elasomeran; route of administration: intramuscular, anatomical location: left deltoid, dose and indication: not reported) (explicitly coded as ''Product administration error''). The batch number was not reported. On the same day, shortly after receiving Flucelvax Quadrivalent and Spikevax, the patient fainted/passed out for less than a minute. Pharmacist called for an ambulance and provided a Coke for the patient to drink in the meantime. Pharmacist stated that patient felt fine after drinking the Coke and walked out with the paramedics. On the same day, the patient recovered from the event. The reporter did not provide a causality assessment. The event of ''faint'' was considered to be medically significant by a Physician within Seqirus''s Pharmacovigilance and Risk Management Department. Company comment: On the same day, shortly after receiving Flucelvax Quadrivalent and Spikevax, the patient fainted for less than a minute. Causality is assessed as possibly related, although confounded by co-suspect. The patient received Flucelvax Quadrivalent and Spikevax on the same day, both in left deltoid. Product administration error is assessed as unrelated per company''s conventions.; Sender''s Comments: On the same day, shortly after receiving Flucelvax Quadrivalent and Spikevax, the patient fainted for less than a minute. Causality is assessed as possibly related, although confounded by co-suspect. The patient received Flucelvax Quadrivalent and Spikevax on the same day, both in left deltoid. Product administration error is assessed as unrelated per company''s conventions.


VAERS ID: 2690014 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated: 2023-09-30
Onset: 2023-10-03
   Days after vaccination: 3
Submitted: 0000-00-00
Entered: 2023-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AU3832B / N/A LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370655 / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immunisation reaction, Injection site rash, Injection site warmth, Rash pruritic
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: COVID Arm, rash formed under site of injection, approx 3in across and 2in tall. Mildly itchy, warm to the touch, not painful. Appeared on 3rd morning after receiving booster shot.


VAERS ID: 2699085 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated: 2023-10-20
Onset: 2023-10-20
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 209F23-2A / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944496 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysgeusia, Feeling hot, Photopsia
SMQs:, Taste and smell disorders (narrow), Retinal disorders (narrow)

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

Write-up: Patient was given the Covid vaccination, then the influenza. Immediately thereafter, patient reported feeling hot, having a strange taste in mouth, and seeing sparkles in her eyes. We had the patient lean forward and put her head between her legs. this appeared to alleviate the symptoms. We monitored the patient in the waiting area for 15 minutes, and she reported no residual symptoms. We informed the side effects to her physician.


VAERS ID: 2698377 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated: 2023-10-19
Onset: 2023-10-19
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Stelara (ustekinumab) 90 mg/1ml injection SQ one time every 8 weeks for ulcerative colitis
Current Illness: none
Preexisting Conditions: ulcerative colitis
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: The adverse event was wrong vaccination. I did NOT request to receive the Pfizer COVID 19 shot, I requested the flucelvax shot. I was given the Pfizer COVID 19 shot without my knowledge or consent.


VAERS ID: 2693240 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated: 2023-10-05
Onset: 2023-10-05
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3030342 / 4 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 374409 / 1 LA / IM

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

Write-up: Patient received both vaccines and appeared to be fine. His son was also getting 2 vaccines and he got his vaccines after his father got his first. The father stood there and held his son''s hand and the 2 of them talked to each other while the vaccines were administered. Shortly after his son got his shot the patient passed out. I do not know if it was the actual shots given to the patient or if seeing his son getting shots in the arm contributed to him fainting


VAERS ID: 2019397 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated: 2021-12-17
Onset: 2021-12-29
   Days after vaccination: 12
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067H21A / 3 LA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308498 / 1 RA / SYR

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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Singular, Zyrtec, protonix
Current Illness: None
Preexisting Conditions: Asthma
Allergies: Nexium, Prevacid
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Hives started 12 days after vaccination and hives are still present 10 days later. Increased dosage of Antihistamine. It helps symptoms but does not get rid of hives.


VAERS ID: 2693260 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated: 2023-10-07
Onset: 2023-10-07
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 8058581 / 4 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370660 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pain
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: Similar events for all three previous COVID vaccines
Other Medications: 40 mg Paxil 10mg Lunesta Lo lo estrin fe (activated)
Current Illness: No
Preexisting Conditions: Anxiety PMDD
Allergies: Latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extreme full body aches that lasted for about 20 hours after receiving.


VAERS ID: 2057988 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated: 2022-01-23
Onset: 2022-01-23
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK9729 / 1 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308498 / 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: n/a
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: patient received a flu vaccination and a Pfizer covid vaccination. Patient fainted after vaccination but quickly regained consiousness


VAERS ID: 2031885 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated: 2021-02-27
Onset: 2021-03-02
   Days after vaccination: 3
Submitted: 0000-00-00
Entered: 2022-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Musculoskeletal stiffness, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (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: Lithium Carbonate 1200 mg daily Benefiber 3 doses daily Allegra 180 mg daily Baby Aspirin one tablet daily
Current Illness: Prostate Cancer Essential Tremor
Preexisting Conditions: Essential Tremor since 1987
Allergies: None (except poison ivy and mosquitoes)
Diagnostic Lab Data: I was examined for a stiff neck in my Primary Care Physician''s office sometime in July 2021.
CDC Split Type:

Write-up: On the morning of MArch 3, and for several weeks following, I woke up from sleeping overnight to find joint and muscle pain over my entire body, especially shoulders and hips. The pain gradually subsided over several weeks, only to resume ten days (on March 30) after the second vaccination on March 20, and again about two weeks after the booster on Oct 9. The pain after the booster persists to this day, especially in the shoulders.


VAERS ID: 2277827 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated: 2021-10-09
Onset: 2021-10-24
   Days after vaccination: 15
Submitted: 0000-00-00
Entered: 2022-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH L. 3012SBA / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Dizziness, Dyspnoea, Fatigue, Haematoma, Haemorrhage subcutaneous, Hypoaesthesia, Laboratory test, Menstruation delayed, Menstruation irregular, Pain
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Fertility disorders (broad), Sexual dysfunction (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: Modafinil, Synthroid, Xywav, Vit B12, B-complex, Vit D, probio
Current Illness: N/A
Preexisting Conditions: Type 1 Narcolepsy (with cataplexy), Hashimoto''s Thyroiditis, Raynaud''s
Allergies: Penicillin, Keflex
Diagnostic Lab Data: S On 11/29/21 blood was drawn for these tests:
CDC Split Type:

Write-up: Bleeding under the skin in foot and hand accompanied by some dizzyness, shortness of breath, fatigue. Pain and numbness at sites of hematomas. Saw primary care doctor who evaluated and referred me to hematologist. Saw Oncology who ordered lab work and when reviewing the results with me communicated no known cause for the hematomas which were by then resolved and have not recurred. Additionally, my menstrual period was due around 10/09/21, the same day of my vaccinations. I did not get my period when it was due, and the start of my next menstrual cycle was 126 days later, on 01/16/2022.


VAERS ID: 2713162 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated: 2023-11-13
Onset: 2023-11-01
Submitted: 0000-00-00
Entered: 2023-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3031280 / 4 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944457 / 6 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Compazine 10mg daily as needed, Zofran 4mg daily as needed, prenatal vitamin daily, calcium 600 + D3 daily, Stivarga 40mg 3 tablets daily for 3 weeks (off 1 week then repeat), Phospha 250 neutral 250 mg 1 tablet 4 times daily, nasonex 50mcg
Current Illness: metastatic gastrointestinal stromal tumors stave IV, anxiety, depression, migraines
Preexisting Conditions: metastatic gastrointestinal stromal tumors stave IV, anxiety, depression, migraines
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Thursday 11/9 around 3pm noticed red bumps all over my arms, torso, legs back, and chest - non itchy at this time. Called my PCP, got an appointment for Friday 11/10 at 3:30pm, by this time the bumps were starting to itchy slightly. The bumps had multiplied and gotten bigger and redder. Was prescribed Prednisone 10 mg - 4 pills for 5 days, 3 pills for 3 days, 2 pills for 3 days


VAERS ID: 2693273 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated: 2023-10-09
Onset: 2023-10-09
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 5 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / N/A RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Muscle spasms, Myalgia, Sleep disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Dystonia (broad), Eosinophilic pneumonia (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: Meningitis B - allergic reaction; covid dose 2 - chills/sweats
Other Medications: Escitalopram, bupropion xl, zyrtec, symbicort, daily chewable vitamin w/iron (pediatric), clobetasol topical
Current Illness: None
Preexisting Conditions: Asthma, food and seasonal allergies, depression, anxiety
Allergies: Treenuts, shellfish, cephalosporins
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Began with fatigue around 3PM progressing into chills, muscle aches, and cramps. The chills and muscle pains prevented sleep.


VAERS ID: 2698195 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated: 2023-10-18
Onset: 2023-10-18
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HG9498 / 5 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370649 / UNK RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Feeling hot, Hyperhidrosis, Malaise, Throat irritation
SMQs:, Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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 returned in 30 minutes complaining of scratchy throat, feeling hot/sweaty, and generally unwell. Was not having difficulty swallowing or breathing. Offered patient diphenhydramine for mild allergic-type reaction. Patient reported feeling better 45 minutes later.


VAERS ID: 2664871 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Puerto Rico  
Vaccinated: 2017-01-13
Onset: 2021-05-15
   Days after vaccination: 1583
Submitted: 0000-00-00
Entered: 2023-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 2 - / OT
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK - / OT
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 276580 / UNK - / OT
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / OT
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH FJ2604 / UNK - / OT
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS 3IS9E / UNK - / OT
VARZOS: ZOSTER (SHINGRIX) / GLAXOSMITHKLINE BIOLOGICALS HY4GT / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal distension, Abdominal pain, Anion gap, Arthritis, Asthenia, Back pain, Bladder disorder, Blood osmolarity, Blood pressure measurement, Body temperature, Bone pain, Bronchitis, C-reactive protein, Carbon dioxide, Condition aggravated, Constipation, Diarrhoea, Dizziness, Drug ineffective, Dysuria, Eosinophil count, Erythema, Fall, Feeding disorder, Feeling abnormal, Gait inability, Gynaecomastia, Haemorrhage, Headache, Heart rate, Heart rate irregular, Hepatic steatosis, Hernia, Liver disorder, Lymphocyte count, Monocyte count, Mycoplasma test, Myocardial infarction, Nasal congestion, Neoplasm, Nipple swelling, Oropharyngeal pain, Oxygen saturation, Pain, Pain in extremity, Peripheral swelling, Physical examination, Pyrexia, Red cell distribution width, Renal disorder, Respiratory rate, SARS-CoV-2 test, Sepsis, Swelling, Testicular operation, Testicular pain, Testicular swelling, Treponema test, White blood cell count
SMQs:, Cardiac failure (broad), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Lack of efficacy/effect (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Pseudomembranous colitis (broad), Embolic and thrombotic events, arterial (narrow), Dystonia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiac arrhythmia terms, nonspecific (narrow), Vestibular disorders (broad), Lipodystrophy (broad), Osteonecrosis (broad), Hypersensitivity (broad), Arthritis (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Non-haematological tumours of unspecified malignancy (narrow), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad), 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? Yes, ? days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: ZIPRASIDONE HYDROCHLORIDE; SPIRONOLACTONE; GLYCERYL TRINITRATE; GLYCERYL TRINITRATE; GUAIFENESIN; DEPAKOTE ER; ALPRAZOLAM; PANADOL; MORPHINE SULFATE; GENVOYA; STRIBILD; CHOLECALCIFEROL; DEXILANT; PERCOCET [OXYCODONE HYDROCHLORIDE;PARACETAMO
Current Illness: Allergic reaction; Blurred vision; Cancer; Coronary artery disease; Disorder circulatory system (chronic heart or circulatory system disease.); Dyspnea; Fever; Headache; HIV positive (last 35 years); Intermittent fever; Multiple sclerosis; Neurovascular conflict; Obstructive airways disorder; Painful urination (Urine with discomfort); Pelvic pain; Pulmonary tuberculosis; Renal disorder; Spinal stenosis; Transient ischemic attack
Preexisting Conditions: Medical History/Concurrent Conditions: Acute pneumonia; Antisocial personality disorder; COVID-19 (5 months); Depressive disorder; Endoscopy; Family stress; Hernia; Herpes simplex; Opioid abuse; Comments: Denied vomiting , diarrhea, no another symptoms. Patient has not experienced corona.
Allergies:
Diagnostic Lab Data: Test Date: 20220914; Test Name: AGAP; Test Result: 8.2 {DF}; Result Unstructured Data: Normal range: 10 to 20; Test Date: 20220914; Test Name: OSMO; Result Unstructured Data: (Test Result:274,Unit:unknown); Test Date: 20220728; Test Name: blood presure; Test Date: 20220914; Test Name: blood presure; Test Date: 20220914; Test Name: Body temperature; Test Result: 36.8 {DF}; Test Date: 20220914; Test Name: Blood CO2; Test Result: 32.8 {DF}; Result Unstructured Data: Normal Range: 20 to 31; Test Date: 20220914; Test Name: C reactive protein; Test Result: 1.1 {DF}; Result Unstructured Data: normal high: 1; Test Date: 20220914; Test Name: Eosinophil; Test Result: 0.63 {DF}; Result Unstructured Data: (Test Result:0.63,Unit:x10(3)/uL); Test Date: 20220728; Test Name: Pulse; Test Result: 70 {DF}; Test Date: 20220914; Test Name: Pulse; Test Result: 78 {DF}; Test Date: 20220914; Test Name: Lymphocyte; Result Unstructured Data: 4.50 (Normal range: 0.77 to 2.96); Test Date: 20220914; Test Name: Monocyte; Test Result: 1.29 {DF}; Test Date: 20210104; Test Name: Mycoplasma; Result Unstructured Data: (Test Result:Non reactive,Unit:unknown); Test Date: 20220728; Test Name: Saturation; Test Result: 93 %; Test Date: 20220914; Test Name: Saturation; Test Result: 94 %; Test Date: 20220728; Test Name: Physical examination; Result Unstructured Data: (Test Result:Palpable umbliccal hernia,Unit:unknown); Test Date: 20220914; Test Name: Physical examination; Result Unstructured Data: (Test Result:tenderness,Unit:unknown) Abdominal tenderness; Test Date: 20220914; Test Name: RDW; Test Result: 49.8 {DF}; Result Unstructured Data: Normal Range: 35.3 to 46.9; Test Date: 20220728; Test Name: respiration rate; Result Unstructured Data: 16; Test Date: 20220914; Test Name: respiration rate; Result Unstructured Data: 17; Test Date: 20210104; Test Name: Covid 19; Result Unstructured Data: (Test Result:Negative,Unit:unknown); Test Date: 20211130; Test Name: Covid 19; Result Unstructured Data: (Test Result:Negative,Unit:unknown); Test Date: 20220214; Test Name: Covid 19; Result Unstructured Data: (Test Result:Negative,Unit:unknown); Test Date: 20220630; Test Name: Covid 19; Result Unstructured Data: (Test Result:Negative,Unit:unknown); Test Date: 20220728; Test Name: Covid 19; Result Unstructured Data: (Test Result:Negative,Unit:unknown); Test Date: 20220810; Test Name: Covid 19; Result Unstructured Data: (Test Result:Negative,Unit:unknown); Test Date: 20220816; Test Name: Covid 19; Result Unstructured Data: (Test Result:Negative,Unit:unknown); Test Date: 20220907; Test Name: Covid 19; Result Unstructured Data: (Test Result:Negative,Unit:unknown); Test Date: 20220914; Test Name: Covid 19; Result Unstructured Data: (Test Result:Negative,Unit:unknown); Test Date: 20210512; Test Name: Syphilis serology; Result Unstructured Data: (Test Result:non reactive,Unit:unknown); Test Date: 20220914; Test Name: WBC; Test Result: 14.31 {DF}
CDC Split Type: PRSA2023SA194600

Write-up: SEPSIS; ACUTE BRONCHITIS; Heart attack; Discharging blood; Persistent hands swellness with pain on the fingers articulations; they put me on Morphine and I feel like a little dizzy; my body swells I do not know if it swelled my fingers,my feet, Leg swelling; He fell; Sore throat; to operate my chest; have a big, like a big ball inside in both one; fatty liver; I have fevers everyday 2 or 3 times a day; Testicle surgery; got a lot of pain in my belly; Chronic diarrhea; nipples swelling; belly is swollen huge,got a lot of pain in my belly,My belly looks l ke I am nine months pregnant;; I am doing worse; liver is real bad; all those things like my liver, it is not working how it is supposed to be,Everything in the body is getting worse,my body is real worse; redness on the vaccine area right arm; can''t urinate almost, just drops of urine; Hernia; my bones, it hurts a lot; Congestion; I am doing worse; liver is real bad; all those things like my liver, it is not working how it is supposed to be; Tumor; Kidneys are not working; Strong pain in my testicles and swelling; Then constipation for 2 months; I cannot put my clothes; I cannot walk; I have stayed in bed; Strong pain in my testicles and swelling; bladder dyskinesis; have a lot of pain in my body that hurts a lot and I been for six months with all this; headache; Leg swelling; I was feeling really bad,I am feeling l ke I am dying slowly; I cannot put my clothes; I cannot walk; I have stayed in bed; cannot wash dishes, stay doing something because it,hurts in my back, Very strong pain in the lower part of the back for 5 months and ongoing; I cannot drink or eat anything; Panadol doesn''t make anything for me,take two of them and it doesn''t make any difference for the pain,I was drinking two Percocet every four hours and they don''t do me anything; Severe arthritis; Irregular heartbeats; Initial information regarding this unsolicited valid Serious case downloaded from database, was received on 23-Jun-2023 from a Non-health care professional via Health Authorities under reference US-HALEON-USCH2022AMR028047. The following narrative is based on the information retrieved from all other accessible data. This case involves 57 years old male patient (168 cm and 79.83 kg) who experienced sepsis, acute bronchitis, heart attack, discharging blood, persistent hands swellness with pain on the fingers articulations, they put me on morphine and i feel like a little dizzy, irregular heartbeats, my body swells i do not know if it swelled my fingers,my feet, leg swelling, he fell, sore throat, to operate my chest; have a big, like a big ball inside in both one, severe arthritis, fatty liver, i have fevers everyday 2 or 3 times a day, testicle surgery, got a lot of pain in my belly, chronic diarrhea, nipples swelling, belly is swollen huge,got a lot of pain in my belly,my belly looks l ke i am nine months pregnant;, i am doing worse; liver is real bad; all those things like my liver, it is not working how it is supposed to be,everything in the body is getting worse,my body is real worse, redness on the vaccine area right arm, can''t urinate almost, just drops of urine, hernia, my bones, it hurts a lot, congestion, i am doing worse; liver is real bad; all those things like my liver, it is not working how it is supposed to be, tumor, kidneys are not working, strong pain in my testicles and swelling, then constipation for 2 months, i cannot put my clothes; i cannot walk; i have stayed in bed, strong pain in my testicles and swelling, bladder dyskinesis, have a lot of pain in my body that hurts a lot and i been for six months with all this, headache, leg swelling, i was feeling really bad,i am feeling l ke i am dying slowly, i cannot put my clothes; i cannot walk; i have stayed in bed, cannot wash dishes, stay doing something because it,hurts in my back, very strong pain in the lower part of the back for 5 months and ongoing, i cannot drink or eat anything and panadol doesn? make anything for me,take two of them and it doesn? make any difference for the pain,i was drinking two percocet every four hours and they don? do me anything while receiving vaccines PFIZER BIONTECH COVID-19 VACCINE, Fluarix, PREVNAR, Flucelvax QUAD and influenza vaccine and while treated with salbutamol sulfate, lansoprazole, levofloxacin, mirtazapine, Clopidogrel BISULFATE, ranitidine hydrochloride, clonazepam, aciclovir, atorvastatin calcium, ibuprofen, famotidine, pantoprazole sodium, gabapentin, acetylsalicylic acid [ASPIRINE], fluoxetine hydrochloride, mirtazapine, ziprasidone hydrochloride, spironolactone, glyceryl trinitrate, fenofibrate, guaifenesin, valproate SEMISODIUM [Depakote emergency room], alprazolam, paracetamol [PANADOL], morphine sulfate, cobicistat, elvitegravir, emtricitabine, Tenofovir ALAFENAMIDE FUMARATE [Genvoya], cobicistat, elvitegravir, emtricitabine, Tenofovir DISOPROXIL FUMARATE [Stribild], colecalciferol [cholecalciferol], dexlansoprazole [Dexilant], VARICELLA ZOSTER VACCINE RGE (CHO) [Shingrix], oxycodone hydrochloride, paracetamol [Percocet [oxycodone hydrochloride;paracetamol]], DIPHTHERIA VACCINE TOXOID, PERTUSSIS VACCINE ACELLULAR 3-COMPONENT, TETANUS VACCINE TOXOID [Boostrix], Fluticasone propionate, olodaterol hydrochloride, tiotropium bromide MONOHYDRATE [Stiolto RESPIMAT], nabumetone, estazolam, cobicistat, darunavir ETHANOLATE, emtricitabine, Tenofovir ALAFENAMIDE FUMARATE [Symtuza] and abacavir sulfate, dolutegravir sodium, lamivudine [Triumeq]. The patient''s past medical history included Herpes simplex, Endoscopy on 29-Jul-2015, COVID-19 with 5 months, Family stress, Antisocial personality disorder, Acute pneumonia, Depressive disorder, Hernia on 10-Sep-2022 and Opioid abuse. The patient''s past medical treatment included diphenhydramine, hydroxyzine and tramadol. The patient''s past vaccination(s) and family history were not provided. At the time of the event, the patient had ongoing Cancer, HIV positive in Jun-1979 with last 35 years, Blurred vision, Fever on 08-Jul-2021, Transient ischemic attack, Spinal stenosis, Dyspnea, Allergic reaction, Pelvic pain in Sep-2022, Painful urination in Sep-2022 with Urine with discomfort, Coronary artery disease, Pulmonary tuberculosis, Intermittent fever in Sep-2022, Headache on 08-Jul-2021, Disorder circulatory system with chronic heart or circulatory system disease., Renal disorder, Neurovascular conflict, Obstructive airways disorder and Multiple sclerosis. Notes: Denied vomiting , diarrhea, no another symptoms. Patient has not experienced corona. On 20-Dec-2019, the patient started taking Shingrix (VARICELLA ZOSTER VACCINE RGE (CHO)) formulation unknown dosage unknown intramuscular (lot - HY4GT) for Shingles. On 03-Mar-2020 Shingrix (VARICELLA ZOSTER VACCINE RGE (CHO)) dosage was changed to dosage unknown. On 04-May-2022, the patient started taking Boostrix (DIPHTHERIA VACCINE TOXOID, PERTUSSIS VACCINE ACELLULAR 3-COMPONENT, TETANUS VACCINE TOXOID) formulation unknown 0.5 mL intramuscular (lot - 3is9e) for Cough. On an unknown date, the patient started taking salbutamol sulfate at a dsoe of 90 ug As needed (with an unknown batch number) for Product used for unknown indication, lansoprazole at a dose of 30 mg daily orally (with an unknown batch number) for Drug use for unknown indication, levofloxacin at a dose of 500 mg daily orally (with an unknown batch number) for Drug use for unknown indication, mirtazapine at a dose of 15 mg oral (with an unknown batch number), Clopidogrel BISULFATE at a dose of 75 mg daily orally (with an unknown batch number) for Drug use for unknown indication, ranitidine hydrochloride at a dose of 300 mg daily orally (with an unknown batch number) for Drug use for unknown indication, clonazepam at a dose of 1 mg daily orally (with an unknown batch number) for Drug use for unknown indication, aciclovir at a dose of 400 mg every 12 hours oral (with an unknown batch number) for Product used for unknown indication, atorvastatin calcium at a dose of 40 mg daily orally (with an unknown batch number) for Drug use for unknown indication, ibuprofen Unknown dosage unknown (with an unknown batch number) for Pain, famotidine at a dose of 80 mg daily orally (with an unknown batch number) for Drug use for unknown indication, pantoprazole sodium at a dose of 40 mg oral (with an unknown batch number) for Drug use for unknown indication, gabapentin at a dose of 800 mg oral (with an unknown batch number) for Drug use for unknown indication, ASPIRINE (acetylsalicylic acid) Unknown dosage unknown (with an unknown batch number) for Pain, fluoxetine hydrochloride at a dose of 20 mg daily orally (with an unknown batch number) for Drug use for unknown indication, mirtazapine at a dose of 60 mg daily orally (with an unknown batch number) for Drug use for unknown indication, ziprasidone hydrochloride at a dose of 80 mg daily orally (with an unknown batch number) for Drug use for unknown indication, spironolactone at a dose of 25 mg daily orally (with an unknown batch number) for Drug use for unknown indication, glyceryl trinitrate Unknown dosage unknown sublingual (with an unknown batch number) for Product used for unknown indication, fenofibrate at a dose of 145 mg oral (with an unknown batch number) for Drug use for unknown indication, guaifenesin at a dose of 10 mL Q6H oral (with an unknown batch number) for Drug use for unknown indication, Depakote emergency room (valproate SEMISODIUM) at a dose of 500 mg oral (with an unknown batch number) for Drug use for unknown indication, alprazolam at a dose of 6 mg daily orally (with an unknown batch number) for Drug use for unknown indication, PANADOL (paracetamol) Unknown dosage unknown (with an unknown batch number) for Pain, morphine sulfate Unknown dosage unknown (with an unknown batch number) for Drug use for unknown indication, Genvoya (cobicistat, elvitegravir, emtricitabine, Tenofovir ALAFENAMIDE FUMARATE) Tablet 1 dosage form daily orally (with an unknown batch number) for Drug use for unknown indication, Stribild (cobicistat, elvitegravir, emtricitabine, Tenofovir DISOPROXIL FUMARATE) Tablet 1 dosage form daily orally (with an unknown batch number) for Drug use for unknown indication, cholecalciferol (colecalciferol) formulation unknown 1000 U oral (with an unknown batch number) for Drug use for unknown indication, Dexilant (dexlansoprazole) at a dose of 60 mg oral (with an unknown batch number) for Drug use for unknown indication, Percocet [oxycodone hydrochloride;paracetamol] (oxycodone hydrochloride, paracetamol) formulation unknown dosage unknown (with an unknown batch number) for Drug use for unknown indication, Fluticasone propionate at a dose of 32 g daily (with an unknown batch number) for Drug use for unknown indication, Stiolto RESPIMAT (olodaterol hydrochloride, tiotropium bromide MONOHYDRATE) formulation unknown 4 g daily (with an unknown batch number) for Drug use for unknown indication, nabumetone formulation unknown 500 mg oral (with an unknown batch number) for Drug use for unknown indication, estazolam formulation unknown 2 mg oral (with an unknown batch number) for Drug use for unknown indication, Symtuza (cobicistat, darunavir ETHANOLATE, emtricitabine, Tenofovir ALAFENAMIDE FUMARATE) formulation unknown dosage unknown (with an unknown batch number) for Drug use for unknown indication and Triumeq (abacavir sulfate, dolutegravir sodium, lamivudine) formulation unknown dosage unknown (with an unknown batch number) for Drug use for unknown indication. On 09-Dec-2020, the patient received a dose of suspect Flucelvax QUAD not produced by Sanofi Pasteur lot 276580 via intramuscular route in unknown administration site for immunization. On 04-May-2022, the patient received a dose of suspect PREVNAR not produced by Sanofi Pasteur lot FJ2604 via intramuscular route in unknown administration site for prophylactic vaccination. On 13-Jan-2017, the patient received a dose of suspect Fluarix not produced by Sanofi Pasteur lot number not reported via unknown route in unknown administration site for unknown indication. On 10-May-2022, the patient received a dose 4 dose of suspect PFIZER BIONTECH COVID-19 VACCINE not produced by Sanofi Pasteur lot FM7553 via intramuscular route in unknown administration site. On 13-Apr-2021 he also received a dose 2 dose of the same vaccine lot EW0151 via intramuscular route in unknown administration site. On 20-Aug-2021 he also received a dose 3 dose of the same vaccine lot FC3183 via intramuscular route in unknown administration site for unknown indication. On 23-Mar-2021 he also received a dose 1 dose of the same vaccine lot EP7534 via intramuscular route in unknown administration site for unknown indication. On 21-Sep-2021, the patient received a dose of suspect influenza vaccine produced by unknown manufacturer lot number not reported via unknown route in unknown administration site for flu vaccination. On the patient had serious events of sepsis, acute bronchitis, heart attack, discharging blood and non-serious events of persistent hands swellness with pain on the fingers articulations, they put me on morphine and i feel like a little dizzy, irregular heartbeats, my body swells i do not know if it swelled my fingers,my feet, leg swelling, he fell, sore throat, to operate my chest; have a big, like a big ball inside in both one, severe arthritis, fatty liver, i have fevers everyday 2 or 3 times a day, testicle surgery, got a lot of pain in my belly, chronic diarrhea, nipples swelling, belly is swollen huge,got a lot of pain in my belly,my belly looks l ke i am nine months pregnant;, i am doing worse; liver is real bad; all those things like my liver, it is not working how it is supposed to be,everything in the body is getting worse,my body is real worse, redness on the vaccine area right arm, can''t urinate almost, just drops of urine, hernia, my bones, it hurts a lot, congestion, i am doing worse; liver is real bad; all those things like my liver, it is not working how it is supposed to be, tumor, kidneys are not working, strong pain in my testicles and swelling, then constipation for 2 months, i cannot put my clothes; i cannot walk; i have stayed in bed, strong pain in my testicles and swelling, bladder dyskinesis, have a lot of pain in my body that hurts a lot and i been for six months with all this, headache, leg swelling, i was feeling really bad,i am feeling l ke i am dying slowly, i cannot put my clothes; i cannot walk; i have stayed in bed, cannot wash dishes, stay doing something because it,hurts in my back, very strong pain in the lower part of the back for 5 months and ongoing, i cannot drink or eat anything and panadol doesn? make anything for me,take two of them and it doesn? make any difference for the pain,i was drinking two percocet every four hours and they don? do me anything. Action taken with salbutamol sulfate, VARICELLA ZOSTER VACCINE RGE (CHO) (Shingrix), lansoprazole, levofloxacin, mirtazapine, cobicistat, elvitegravir, emtricitabine, Tenofovir DISOPROXIL FUMARATE (Stribild), ranitidine hydrochloride (ranitidine hydrochloride), clonazepam (clonazepam), cobicistat, elvitegravir, emtricitabine, Tenofovir ALAFENAMIDE FUMARATE (Genvoya), ibuprofen (ibuprofen), famotidine (famotidine), dexlansoprazole (Dexilant), colecalciferol (cholecalciferol), Clopidogrel BISULFATE (Clopidogrel BISULFATE), pneumococcal vaccine CONJ 7V (CRM197) (PREVNAR), atorvastatin calcium (atorvastatin calcium), oxycodone hydrochloride, paracetamol (Percocet [oxycodone hydrochloride;paracetamol]), DIPHTHERIA VACCINE TOXOID, PERTUSSIS VACCINE ACELLULAR 3-COMPONENT, TETANUS VACCINE TOXOID (Boostrix), valproate SEMISODIUM (Depakote emergency room), aciclovir (aciclovir), Fluticasone propionate (Fluticasone propionate), paracetamol (PANADOL), olodaterol hydrochloride, tiotropium bromide MONOHYDRATE (Stiolto RESPIMAT), acetylsalicylic acid (ASPIRINE), morphine sulfate (morphine sulfate), nabumetone (nabumetone), guaifenesin (guaifenesin), gabapentin (gabapentin), fenofibrate (fenofibrate), TOZINAMERAN (PFIZER BIONTECH COVID-19 VACCINE), spironolactone (spironolactone), alprazolam (alprazolam), estazolam (estazolam), glyceryl trinitrate (glyceryl trinitrate), cobicistat, darunavir ETHANOLATE, emtricitabine, Tenofovir ALAFENAMIDE FUMARATE (Symtuza), pantoprazole sodium (pantoprazole sodium), fluoxetine hydrochloride (fluoxetine hydrochloride), abacavir sulfate, dolutegravir sodium, lamivudine (Triumeq), MIRTAZAPINERANITIDINE hydrochloride, clonazepam, cobicistat, elvitegravir, emtricitabine, Tenofovir ALAFENAMIDE FUMARATE (Genvoya), ibuprofen, famotidine, dexlansoprazole (Dexilant), colecalciferol (cholecalciferol), Clopidogrel BISULFATE, pneumococcal vaccine CONJ 7V (CRM197) (PREVNAR), atorvastatin calcium, oxycodone hydrochloride, paracetamol (Percocet [oxycodone hydrochloride;paracetamol]), DIPHTHERIA VACCINE TOXOID, PERTUSSIS VACCINE ACELLULAR 3-COMPONENT, TETANUS VACCINE TOXOID (Boostrix), valproate SEMISODIUM (Depakote emergency room), aciclovir, Fluticasone propionate, paracetamol (PANADOL), olodaterol hydrochloride, tiotropium bromide MONOHYDRATE (Stiolto RESPIMAT), acetylsalicylic acid (ASPIRINE), morphine sulfate, nabumetone, guaifenesin, gabapentin, fenofibrate, TOZINAMERAN (PFIZER BIONTECH COVID-19 VACCINE), spironolactone, alprazolam, estazolam, glyceryl trinitrate, cobicistat, darunavir ETHANOLATE, emtricitabine, Tenofovir ALAFENAMIDE FUMARATE (Symtuza), pantoprazole sodium, fluoxetine HYDROCHLORIDEMIRTAZAPINE, cobicistat, elvitegravir, emtricitabine, Tenofovir DISOPROXIL FUMARATE (Stribild), ranitidine hydrochloride (ranitidine hydrochloride), clonazepam (clonazepam), cobicistat, elvitegravir, emtricitabine, Tenofovir ALAFENAMIDE FUMARATE (Genvoya), ibuprofen (ibuprofen), famotidine (famotidine), dexlansoprazole (Dexilant), colecalciferol (cholecalciferol), Clopidogrel BISULFATE (Clopidogrel BISULFATE), pneumococcal vaccine CONJ 7V (CRM197) (PREVNAR), atorvastatin calcium (atorvastatin calcium), oxycodone hydrochloride, paracetamol (Percocet [oxycodone hydrochloride;paracetamol]), DIPHTHERIA VACCINE TOXOID, PERTUSSIS VACCINE ACELLULAR 3-COMPONENT, TETANUS VACCINE TOXOID (Boostrix), valproate SEMISODIUM (Depakote emergency room), aciclovir (aciclovir), Fluticasone propionate (Fluticasone propionate), paracetamol (PANADOL), olodaterol hydrochloride, tiotropium bromide MONOHYDRATE (Stiolto RESPIMAT), acetylsalicylic acid (ASPIRINE), morphine sulfate (morphine sulfate), nabumetone (nabumetone), guaifenesin (guaifenesin), gabapentin (gabapentin), fenofibrate (fenofibrate), TOZINAMERAN (PFIZER BIONTECH COVID-19 VACCINE), spironolactone (spironolactone), alprazolam (alprazolam), estazolam (estazolam), glyceryl trinitrate (glyceryl trinitrate), cobicistat, darunavir ETHANOLATE, emtricitabine, Tenofovir ALAFENAMIDE FUMARATE (Symtuza), pantoprazole sodium (pantoprazole sodium), fluoxetine hydrochloride (fluoxetine hydrochloride), abacavir sulfate, dolutegravir sodium, lamivudine (Triumeq), mirtazapine and ziprasidone hydrochloride was unknown. Action taken with influenza vaccine INACT SAG 4V (Flucelvax QUAD), influenza vaccine INACT SPLIT 3V (Fluarix) and influenza vaccine was not applicable and unknown for all other suspects. It was not reported if the patient received a corrective treatment for all the events. At time of reporting, the outcome was Unknown for all other events and was Not Recovered for the event i have fevers everyday 2 or 3 times a day, nipples swelling. Seriousness criteria : Hospitalization for sepsis and acute bronchitis and Medically significant for sepsis, Heart attack and hemorrhage.; Sender''s Comments: Sanofi Company Comment dated 30-Jun-2023 : This case involves an 57 years old male patient who had sepsis, acute bronchitis, heart attack and hemorrhage while receiving vaccines PFIZER BIONTECH COVID-19 VACCINE, Fluarix, PREVNAR, Flucelvax QUAD and influenza vaccine and while treated with salbutamol sulfate, lansoprazole, levofloxacin, mirtazapine, Clopidogrel BISULFATE, ranitidine hydrochloride, clonazepam, aciclovir, atorvastatin calcium, ibuprofen, famotidine, pantoprazole sodium, gabapentin, acetylsalicylic acid [ASPIRINE], fluoxetine hydrochloride, mirtazapine, ziprasidone hydrochloride, spironolactone, glyceryl trinitrate, fenofibrate, guaifenesin, valproate SEMISODIUM [Depakote emergency room], alprazolam, paracetamol [PANADOL], morphine sulfate, cobicistat, elvitegravir, emtricitabine, Tenofovir ALAFENAMIDE FUMARATE [Genvoya], cobicistat, elvitegravir, emtricitabine, Tenofovir DISOPROXIL FUMARATE [Stribild], colecalciferol [cholecalciferol], dexlansoprazole [Dexilant], VARICELLA ZOSTER VACCINE RGE (CHO) [Shingrix], oxycodone hydrochloride, paracetamol [Percocet [oxycodone hydrochloride;paracetamol]], DIPHTHERIA VACCINE TOXOID, PERTUSSIS VACCINE ACELLULAR 3-COMPONENT, TETANUS VACCINE TOXOID [Boostrix], Fluticasone propionate, olodaterol hydrochloride, tiotropium bromide MONOHYDRATE [Stiolto RESPIMAT], nabumetone, estazolam, cobicistat, darunavir ETHANOLATE, emtricitabine, Tenofovir ALAFENAMIDE FUMARATE [Symtuza] and abacavir sulfate, dolutegravir sodium, lamivudine [Triumeq]. Based on the limited information provided regarding this case, causal role of the company suspect product cannot be excluded. However, lack of information of patient''s past and concomitant medication and any family history, lab data and indication of drug precludes comprehensive case assessment. Further, the patient medical history would be cofounding factor for this events.


VAERS ID: 2494108 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Rhode Island  
Vaccinated: 2022-09-09
Onset: 2022-10-17
   Days after vaccination: 38
Submitted: 0000-00-00
Entered: 2022-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AS714JB / 5 RA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Deep vein thrombosis, Peripheral vein occlusion, Ultrasound Doppler abnormal
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Minoxidil 2.5mg 1x/daily
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Ultasound of left leg venous
CDC Split Type:

Write-up: DVT in left leg, positive occlusive DVT right femoral vein and popliteal vein


VAERS ID: 2692587 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: South Carolina  
Vaccinated: 2023-10-03
Onset: 2023-10-04
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HG4628 / UNK AR / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370655 / UNK AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Oral pruritus, Pain in extremity, Pruritus
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1) Itching on extremities, mouth (side where vaccine was given 2) Fingers numb (on injection arm side) Feet numb 3) Excruciating pain (In injection arm)


VAERS ID: 1912149 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: South Carolina  
Vaccinated: 2021-11-01
Onset: 2021-11-30
   Days after vaccination: 29
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045J21A / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308460 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Injection site pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (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: First 2 Moderna doses had similar reactions. Shingles vaccine one and two resulted in fever, chills, nausea, bedridden for 3-5 d
Other Medications: Zyrtec, omega-3 with vitamin D, elderberry, zinc, woman?s multi vitamin , Avodart, probiotic, estradiol, rogaine topical solution
Current Illness: Migraines
Preexisting Conditions: Migraines, hives, hair loss
Allergies: Codiene, sulfanilamides, tomatoes, egg whites
Diagnostic Lab Data: None yet
CDC Split Type:

Write-up: Chills, headache, 102? fever, tiredness, sore arms at injection site


VAERS ID: 2692336 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: South Carolina  
Vaccinated: 2023-10-05
Onset: 2023-10-06
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HF9275 / 5 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370652 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth, Musculoskeletal stiffness, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Similar swelling, pain and redness at injection site, length 8?, left upper arm- at seven days AFTER injection; no reaction at/
Other Medications: Adderall 30mg, Wellbutrin 300mg, Tylenol extra strength, Pristiq, AmbienCR
Current Illness: None
Preexisting Conditions: Fibromyalgia
Allergies: Morphine, IV Contrast dye
Diagnostic Lab Data:
CDC Split Type:

Write-up: 2.5? x 5? raised, swollen, red area on upper left arm, at injection site Painful and hot to touch Low grade fever and myalgia, headache, stiff neck


VAERS ID: 1888058 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: South Carolina  
Vaccinated: 2021-11-20
Onset: 2021-11-20
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308454 / 1 RA / IM

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

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

Write-up: Patient reported feeling dizzy about 10 mins after vaccine administration. She lied down on exam table for about 30 mins and felt better. VS stable. Her spouse came to pick her up.


VAERS ID: 2729891 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: South Carolina  
Vaccinated: 2023-11-15
Onset: 2023-11-29
   Days after vaccination: 14
Submitted: 0000-00-00
Entered: 2024-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HF9299 / 4 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 37461 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Breast swelling, Breast tenderness, Erythema, Inflammation, Mammogram, Ultrasound breast
SMQs:, Anaphylactic reaction (broad), Angioedema (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: Novolin NPH insulin 2 units in the AM and 2 units in the PM
Current Illness: None
Preexisting Conditions: Diabetes Type II
Allergies: Wheat and red cedar trees
Diagnostic Lab Data: I went to my dermatologist first to rule out an infection on Dec. 5th. I went to my OB/GYN the next day and was referred for a diagnostic mammogram and ultrasound of the right breast on Dec. 11th. I was called back in for a repeat diagnostic mammogram of the swollen red area of my right breast on Dec. 19th and referred to an oncology surgeon, Dr.. I saw Dr. on Jan. 2nd, 2024. She reviewed my scans and did a physical exam. Breast changes were benign. The explanation I received was that as a result of a prior cone procedure in the upper right quadrant of the right breast that was done 10 years ago it damaged the lymph drainage in that breast. That, in combination with the inflammation caused by the COVID-19 vaccine caused the egg sized swollen and tender area in the lower left quadrant of my right breast. The redness and swelling are gradually fading, no biopsy was needed.
CDC Split Type:

Write-up: Fourteen days after my COVID vaccine, I had a giant red swollen area on my right breast. It was the size of an egg, tender, and appeared overnight in the lower left quadrant of my right breast.


VAERS ID: 2705320 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: South Carolina  
Vaccinated: 2023-10-01
Onset: 2023-10-01
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills
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: Furosemide 40 mg Vimpat 100 mg Vimpat 150 mg Keppra 750 mg Gabapentin 300mg Acetaminophen 500 mg
Current Illness: H. Pylori
Preexisting Conditions: Stroke survivor Psoriatic arthritis
Allergies: Sulfur Methotrexate
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe chills and shivering, lasted over 2 hours


VAERS ID: 2724370 (history)  
Form: Version 2.0  
Age: 1.0  
Sex: Male  
Location: South Carolina  
Vaccinated: 2023-12-14
Onset: 2023-12-14
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / UNK - / -
HEPA: HEP A (VAQTA) / MERCK & CO. INC. - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dose administered, Product preparation 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: 6 months-4 year dose of COVID-19 vaccine was administered in its undiluted form. While this is an error, I feel very strongly that this is a manufacturer issue that needs to be resolved. It is highly confusing for the clinical staff to have 3 versions of a vaccine based on age, 2 of which are ready to use, and one requiring dilution AND in a multidose form.


VAERS ID: 2595680 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: South Dakota  
Vaccinated: 2023-03-13
Onset: 2023-03-13
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 074B22A / 1 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 353625 / 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: Naproxen, Prazosin, sertraline, hydroxyzine
Current Illness:
Preexisting Conditions: diabetes, hyperlipidemia, Alcohol abuse, depressive disorder,
Allergies: no known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT GIVEN outdated Moderna vaccine on 3/13/2023 , outdated 3/11/2023


VAERS ID: 1849095 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Tennessee  
Vaccinated: 2021-11-06
Onset: 2021-11-06
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058F21A / 3 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308460 / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), 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: UNKNOWN
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was seating in her chair after getting her vaccine and she passed out while waiting in chair and fell down on floor. She did not remember what happened to her and she was in senses after about 10 seconds. We rush to her form pharmacy to waiting area and by the time we reach to her she wan in senses. Her friend was with her who also got the same shot. I asked about her health and she said she is perfectly fine . Her communication was to the point, her vision was normal and she had no complaints of injury in her body. Then she rested in chair for little over 15 minutes and then left. I frequently checked her while waiting she she was fine. They left pharmacy after 20 minutes of waiting and she was fine when leaving the pharmacy waiting area.


VAERS ID: 1854888 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Tennessee  
Vaccinated: 2021-11-03
Onset: 2021-11-03
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 1 RL / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308483 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Wrong 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: unknown
Current Illness: none
Preexisting Conditions: none
Allergies: no known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient''s guardian was counseled on patient receiving flucelvax flu shot. Guardian declined going into immunization room during service. Patient confirmed he was expecting to get the flu shot. After flucelvax was administered, guardian stated patient wanted the covid vaccine and not the flu shot. Guardian agreed to administer covid vaccine on the same day of service.


VAERS ID: 2496608 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Female  
Location: Tennessee  
Vaccinated: 2022-11-01
Onset: 2022-11-01
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FT1551 / 3 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 942372 / 1 LA / IM

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? 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: NKA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: The child had an appt. scheduled on Tuesday 11/1/22 at 3:30pm for a COVID-19 Booster. Clinic that day for myself being the nurse scheduled had been busy/hectic. The Nursing Assistant offered to help me & went to the pharmacy to remove a vial of the 5yr-11yr. COVID-19 vaccine from the refrigerator for me to dilute & draw up the appropriate dose for the child. The child was due for her first Bivalent booster. I, the nurse, had trusted that the nursing assistant had removed the correct vial of 5yr-11r Bivalent vaccine. The vaccine was brought to my clinic room along with sterile diluent. I noticed that the diluent was the incorrect kind that was needed & I took the covid vaccine with me to the pharmacy & I obtained the normal saline diluent that I needed to dilute the covid vaccine. I diluted per covid protocol & then drew up the correct dose for the child. I administered the dose & had the child to wait with her guardian the allotted time after administration for 15 minutes. It was then I had realized when I was filling out the Pfizer covid sheet & the new covid vaccine card that I had diluted a monovalent 5yr-11yr covid vaccine instead of the Bivalent for the child''s booster. I immediately notified my Nursing Supervisor of the incident occurrence & was further instructed to notify the guardian. I told the guardian of what had taken place & apologized to her. The guardian completely understood & wasn''t upset, but wanted to know when the child would be able to receive the correct Bivalent booster for her age. My supervisor called the Nursing Director & she confirmed in 2 months the child would be able to receive the correct booster. The guardian verbalized all understanding & scheduled an appt. to receive in January 2023. The child has had no reaction or complication to the incorrect booster.


VAERS ID: 2530188 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Tennessee  
Vaccinated: 2022-09-09
Onset: 2022-12-04
   Days after vaccination: 86
Submitted: 0000-00-00
Entered: 2022-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH GH9694 / 4 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 7+ RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Chills, Cough, Oropharyngeal pain, Pain, Pyrexia, SARS-CoV-2 test positive, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vyvanse
Current Illness: N/A
Preexisting Conditions: ADHD
Allergies: N/A
Diagnostic Lab Data: COVID-19 Test, 12/06/2022, Positive
CDC Split Type: vsafe

Write-up: I had cough, sore throat, fever of 100.5, chills, body aches, and wheezing. I tested positive for COVID-19 at home. I talked to my doctor, and he prescribed me Paxlovid. I still have a lingering cough.


VAERS ID: 1920220 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Tennessee  
Vaccinated: 2021-10-29
Onset: 2021-10-31
   Days after vaccination: 2
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 1 RA / SC
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 309616 / 1 LA / SC

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bacterial test negative, Bacterial vaginosis, Chlamydia test, Fungal infection, Neisseria test, Pain, Parasitic test, Pyrexia, Vertigo
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (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: Montelukast, ProAir HFA
Current Illness: none
Preexisting Conditions: asthma HBP
Allergies: Statins and sulfa
Diagnostic Lab Data: Name: (PRIVACY) DOB (PRIVACY) Phone Number: (PRIVACY) Address: (PRIVACY) FINAL RESULT Accession ID: Lab Ref ID: Order Date: 11/22/2021 Collection Date: 11/22/2021 10:48:00 Received: 11/26/2021 19:48:03 Report: 11/26/2021 19:43:00 Specimen Received: 11/23/2021 03:14:00 Requesting Physician:(PRIVACY) Ordering Physician: (PRIVACY) SURESWAB(R), VAGINOSIS/VAGINITIS PLUS NAME VALUE LAB F CHLAMYDIA TRACHOMATIS RNA, TMA, UROGENITAL NOT DETECTED TXC F NEISSERIA GONORRHOEAE RNA, TMA, UROGENITAL NOT DETECTED TXC REFERENCE RANGE: NOT DETECTED Methodology: Transcription Mediated Amplification (TMA) to detect RNA. The analytical performance characteristics of this assay, when used to test specimens have been determined by (PRIVACY). The modifications have not been cleared or approved by the FDA. This assay has been validated pursuant to the regulations and is used for clinical purposes. For additional information, please refer to Website (PRIVACY) (This link is being provided for informational/ educational purposes only.) F LACTOBACILLUS SPECIES NOT DETECTED (Log (cells/mL)) TXC F ATOPOBIUM VAGINAE 6.8 (Log (cells/mL)) TXC F MEGASPHAERA SPECIES 6.4 (Log (cells/mL)) TXC F GARDNERELLA VAGINALIS 7.0 (Log (cells/mL)) TXC F BV CATEGORY: SUPPORTIVE A TXC REFERENCE RANGE: BV Category: NOT SUPPORTIVE Methodology: Real-Time PCR NOT SUPPORTIVE OF BV: The pattern of results is not supportive of a diagnosis of BV: 1) Presence of Lactobacillus spp., G. vaginalis levels less than 6.0 log cells/mL, and absence of A. vaginae and Megasphaera spp; or 2) Absence of all targeted organisms; or 3) Absence of Lactobacillus spp. plus G. vaginalis detected at levels less than 6.0 log cells/mL and absence of A. vaginae and Megasphaera spp. EQUIVOCAL FOR BV: The pattern of results is neither supportive nor not supportive of a diagnosis of BV. The patient may be in transition into or out of BV: Presence of Lactobacillus spp. plus G. vaginalis (greater or equal to 6.0 log cells/mL) and/or one of the other BV-associated pathogens. SUPPORTIVE OF BV: The pattern of results is supportive of a diagnosis of BV: Absence of Lactobacillus spp. and presence of G. vaginalis greater than or equal to 6.0 log cells/mL and/or one or both of the other BV-associated pathogens. Concentration for Lactobacilli (L. acidophilus/crispatus, L. jensenii) are collectively reported under the term "Lactobacillus spp.", as these species are among the peroxide producing Lactobacilli thought to be protective against bacterial vaginosis. Atopobium vaginae, Megasphaera spp., and Gardnerella (greater than 6.0 log cells/mL) have been associated with vaginosis when present in the absence of peroxidase producing Lactobacilli. This test was developed and its analytical performance characteristics have been determined by (PRIVACY). It has not been cleared or approved by FDA. This assay has been validated pursuant to the regulations and is used for clinical purposes. F SURESWAB(R) TRICHOMONAS VAGINALIS RNA, QL, TMA NOT DETECTED TXC REFERENCE RANGE: NOT DETECTED Methodology: Transcription Mediated Amplification (TMA) For additional information, please refer to website: (PRIVACY) (This link is being provided for informational/educational purposes only.) F C. ALBICANS, DNA NOT DETECTED TXC F C. GLABRATA, DNA NOT DETECTED TXC F C. TROPICALIS, DNA NOT DETECTED TXC F C. PARAPSILOSIS, DNA NOT DETECTED TXC REFERENCE RANGE: NOT DETECTED Methodology: Real-Time PCR This test was developed and its analytical performance characteristics have been determined by (PRIVACY). It has not been cleared or approved by FDA. This assay has been validated pursuant to the regulations and is used for clinical purposes.
CDC Split Type:

Write-up: Fever, vertigo x 1 week, bacterial vaginosis that took 3 weeks to get rid of and turned into a yeast infection because as soon as I got it to start to go away it came back when I got the second dose. I had to see my doctor to get rid of it all completely. I had to be on antibiotics for 7 days, 3 times per day that you typically take twice daily then I had to take another one for the yeast infection the antibiotics gave me due to that. It was the worst pain ever for almost a month. I believe the infection is gone but it is still really raw down there. I got my second dose on 11/19/2021 Pfizer as well LOT 330308D at the same location in the RT are subcutaneous and I had another outbreak on top of what I was hoping was finally going away with fever and vertigo and I went to the doctor that Monday on 11/22/2021.


VAERS ID: 2439300 (history)  
Form: Version 2.0  
Age: 4.0  
Sex: Male  
Location: Tennessee  
Vaccinated: 2022-09-08
Onset: 2022-09-01
Submitted: 0000-00-00
Entered: 2022-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FT9142 / 1 RL / IM
DTAPIPV: DTAP + IPV (QUADRACEL) / SANOFI PASTEUR C5970AA / 5 RL / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. AS1595B / 4 RL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. W006584 / 2 LL / SC

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dose administered, 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 known
Current Illness: none known
Preexisting Conditions: Expressive and receptive language disorder as well as an articulation disorder for which he receives speech therapy. Concerns for auditory sensory processing issues
Allergies: none known
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Concern for Covid vaccine given on 9/8/22. Nurse took thawed vial out of refrigerator and diluted with .7ml of sterile diluent that is normally used to dilute the Proquad/MMR/Varicella. Nurse withdrew .2 ml from vial and administered. Wrong diluent used with incorrect amount of diluent. Patient parent notified on 9/8/22 and informed to notify MD of any type of reaction. None has been reported as of 9/10/22.


VAERS ID: 2079211 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Tennessee  
Vaccinated: 2022-01-31
Onset: 2022-01-31
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK9895 / 3 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308453 / UNK LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Breast swelling, Gingival pain, Nodule, Pain in extremity, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Gingival disorders (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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: Lisinopril, ibuprofen, famotidine
Current Illness: None
Preexisting Conditions: HTN, Lupus
Allergies: ASA
Diagnostic Lab Data:
CDC Split Type:

Write-up: At 7:30 PM, 1/31/22, onset of severe pain left arm and shoulder. Pain to "gums". describes as stabbing pain. Followed by swelling to left arm with "knot" at left elbow area. Swelling to left breast on the morning of 2/1/22. Denies redness or rash


VAERS ID: 2607433 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Male  
Location: Tennessee  
Vaccinated: 2023-03-29
Onset: 2023-03-29
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FT1551 / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 348368 / N/A RA / IM

Administered by: Private       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: N/A
Preexisting Conditions: ECZEMA
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt. due for COVID booster (dose #3).Provider ordered bivalent COVID vaccine, 5-11 yrs. old ORANGE CAP for patient, but monovalent COVID vaccine, 5-11 years old ORANGE CAP was administered.


VAERS ID: 1992565 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Tennessee  
Vaccinated: 2021-11-30
Onset: 2021-11-30
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213D21A / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308525 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Imaging procedure, Migraine
SMQs:

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

Write-up: Patient claims that she started having headaches the day after she received the vaccine (received on 11/30/21). She claims that she has been having headaches since then and has since been diagnosed with migraine headaches which she says she may have as many as 4/day. She claims that she has had imaging done which showed no evidence of blood clots in her brain and she has been referred to a neurologist.


VAERS ID: 1872662 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Tennessee  
Vaccinated: 2021-11-11
Onset: 2021-11-12
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / UN
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 RA / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Disorientation, Headache, Hypersomnia, Injection site pain, Lethargy, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (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), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: lisinopril/hctz, rosuvastatin, loratidine, phenylephrine
Current Illness: NA
Preexisting Conditions: high blood pressure, high cholesterol
Allergies: penicillin
Diagnostic Lab Data: None, slept 44 of 48 hours Continued to take phenylephrine, bp and cholesterol meds, no NSAIDs or flu meds or aspirin in accordance with advice following flu shot
CDC Split Type:

Write-up: took both vaccines at once. side effects were minor injection site pain (both sides), then fever, chills, body weakness, aches and pains, nausea, headache, lethargy, disorientation. I have never had side effects from a vaccine before, and the side effects may have come from combining the flu one


VAERS ID: 1964242 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Texas  
Vaccinated: 2021-11-05
Onset: 2021-11-15
   Days after vaccination: 10
Submitted: 0000-00-00
Entered: 2021-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / N/A LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood thyroid stimulating hormone, Condition aggravated, Eye oedema, Face oedema, Full blood count, Metabolic function test, Nausea, Pain, Pruritus, Tremor, Urine analysis, Urticaria
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Benazepril, duloxetine, levothyroxine, meloxicam, medroxyprogesterone, women?s multivitamin, lysine, nasopro, d-mannose I also received the flu shot at the same time as this Pfizer booster.
Current Illness: None
Preexisting Conditions: Fibromyalgia, vitiligo, hypothyroid, depression, anxiety
Allergies: Sulfa, cat, tree, ragweed, grass, mold, roach, latex
Diagnostic Lab Data: No significant results of cbc, cmp, tsh, and UA.
CDC Split Type:

Write-up: Re-activation of chronic hives on entire body, including intermittent edema of lips, eyes, face, and overall body. It started mild a couple of days after I received the shots and has progressively gotten worse. I tried increasing first-line H1 with no solution, so I added second-line H1 and H2. Still no relief, so I increased the second-line H1 and H2 with no relief. Added Doxepin and titrated up gradually, and it?s still not helping. I?m using diphenhydramine spray and having to take oatmeal and baking soda baths multiple times a day, which gives me about 30 minutes of relief. Yesterday was the worst day so far, where it felt like fire ants biting me all over. It was so itchy and painful, I was shaking and nauseous.


VAERS ID: 1888376 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Texas  
Vaccinated: 2021-11-20
Onset: 2021-11-20
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 32030BD / 1 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308458 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immediate post-injection reaction, Injection site rash
SMQs:, Hypersensitivity (narrow)

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

Write-up: Immediately after administration of both vaccines, patient developed a local rash at the injection site.


VAERS ID: 1833965 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Texas  
Vaccinated: 2021-10-28
Onset: 2021-10-29
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 3 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308454 / UNK LA / IM

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

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

Write-up: Right axilla painful/swelling/lump x 3 days


VAERS ID: 2453519 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Texas  
Vaccinated: 2022-09-17
Onset: 2022-09-17
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH GRJ5342 / 4 RA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Hyperhidrosis, Influenza virus test negative, Injection site pain, Migraine, Pain, Pyrexia, SARS-CoV-2 test negative
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (broad)

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

Write-up: 11 pm same day chills and aches started along with soreness at injection site. 10 am 9/18 continuing chills and aches along with tiredness, strong headache/migraine, and low fever of 99, tylenol taken. 2 pm - 5:30 pm 9/18 chills and aches along with sustained fever of 103.8 and headache/migraine, ibuprofen taken at 3 pm. 6 pm 9/18 went to ER, tested for possible flu and Covid came back negative, temperature down to 102.7. 6-9 pm 9/18 waiting at ER, headache pain decreased but full body sweats started. 9 pm 9/18 fever down to 99, migraine cocktail of saline, Benadryl, and Compazine given. 10 pm 9/18 temperature 98.5, migraine subsided. 12 am 9/19 more ibuprofen taken. 9 am 9/19 temperature 99.5, more ibuprofen taken. 1 pm 9/19 temperature normal.


VAERS ID: 2683855 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Texas  
Vaccinated: 2023-09-18
Onset: 2023-09-18
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 202F23A / 4 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Injection site pain, Lymph node pain, Lymphadenopathy, Pain
SMQs:, Extravasation events (injections, infusions and implants) (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: Fatigue, body aches, headache, soreness at injection site, etc following most vaccines
Other Medications: Xyzal, multivitamin, fluticasone nasal spray, Psyllium husks, calcium, vit d3, glucosamine chondroitin, probiotic, eluryng
Current Illness: None
Preexisting Conditions: Endometriosis, heart murmur, hypermobility disorder
Allergies: Sensitive to cocoa, and skin reactions to most steroids (including the fluticasone I take with frequent use), and skin reactions to many scented soaps and lotions
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fatigue, body aches, soreness at injection site in both arms though worse in covid arm, and swollen and sore lymph nodes in left armpit (same side as covid vax), and slight headache.


VAERS ID: 1793963 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Texas  
Vaccinated: 2021-10-10
Onset: 2021-10-16
   Days after vaccination: 6
Submitted: 0000-00-00
Entered: 2021-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blister, Erythema, Pain of skin, Pruritus, Skin warm
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: obisity, high blood pressure, anxiety,
Preexisting Conditions: chronic pain
Allergies: asprin, penicillin, latex, morphine, cipro
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Sudden sever itching, then a dime sized raised liquid filled blister formed. after about 3 after applying green alcohol, the blister flattened to a quarter sized raised disk red in color, formed. it is hot to the touch and sore to the touch. it feels and looks like a blister that appears after a bad burn. there small indention in the center of the disk. It feels as though the body rejected the vaccine and pushed it from the muscle to sub Q under skin.


VAERS ID: 2694187 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Texas  
Vaccinated: 2023-10-09
Onset: 2023-10-10
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 8057965 / 1 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 371562 / 1 LA / IM
VARZOS: ZOSTER (SHINGRIX) / GLAXOSMITHKLINE BIOLOGICALS 22M3K / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Injection site erythema, Oral herpes
SMQs:, Oropharyngeal infections (narrow), Extravasation events (injections, infusions and implants) (broad), Opportunistic infections (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: bilateral arm redness at injection site. cold sores (3) located on bottom lip. No opening eruptions on sores.


VAERS ID: 2073312 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Texas  
Vaccinated: 2021-09-22
Onset: 2021-09-01
Submitted: 0000-00-00
Entered: 2022-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec and Motrin
Current Illness: None
Preexisting Conditions: Asthma
Allergies: Previous allergic reaction to Zee''s PainAid, Lunesta, green tomatoes and Depo-Provera
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe itching of both calves at all hours of the day but flared up the most at night. After a couple of weeks, the itching spread to both thighs (on the front and back) while also continuing on both calves. No topical treatment (including 0.1% Triamcinolone Acetonide Cream) or oral treatment (including Benadryl) alleviated the itching. The itching continued upon receipt of my second Moderna dose on October 20, 2021 and continued for approximately four weeks, finally resolving around Thanksgiving 2021. There have been no flare-ups to date. There was no discoloration or swelling of the skin; just an intense itch. Additionally, my menstrual cycle has been impacted as I now get my period every 14-21 days as opposed to my regular cycle of 28-30 days. This has been the case since receiving my first Moderna vaccine on September 22, 2021.


VAERS ID: 2447724 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Texas  
Vaccinated: 2022-09-16
Onset: 2022-09-16
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 057A22A / 3 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 942381 / 1 LA / IM

Administered by: Private       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: none
CDC Split Type:

Write-up: Patient was given Monovalent Moderna vaccine as a Booster


VAERS ID: 2694604 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Texas  
Vaccinated: 2023-10-07
Onset: 2023-10-08
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HF9275 / UNK LA / OT
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944463 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Axillary mass, Chills, Pain in extremity
SMQs:, 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: ALBUTEROL [SALBUTAMOL]
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INCPV20230016823

Write-up: After receiving my Covid vaccine this past Saturday (07Oct2023). I had rap arm soreness.; I''ve now got a lump under my arm, in the armpit area; Started feeling chills; This is a spontaneous report received from contactable reporter(s) (Consumer or other non HCP). The reporter is the patient. A 54-year-old female patient received bnt162b2 omi xbb.1.5 (COMIRNATY (2023-2024 FORMULA)), on 07Oct2023 as dose number unknown (booster), 0.3ml single (Lot number: HF9275, Expiration Date: Dec2023) at the age of 54 years intramuscular, in left arm for covid-19 immunisation; influenza vaccine inact sag 4v (FLUCELVAX QUAD), on 07Oct2023 as dose number unknown, 1.5 ml single (Lot number: 944463, Expiration Date: Jun2024) for immunisation. The patient''s relevant medical history included: "Asthma" (unspecified if ongoing). Concomitant medication(s) included: ALBUTEROL [SALBUTAMOL] taken for asthma. Vaccination history included: COVID-19 vaccine (primary immunization series complete; unknown manufacturer), for COVID-19 immunization; COVID-19 vaccine (dose number unknown (booster), manufacturer unknown), administration date: Oct2022, for COVID-19 immunization. The following information was reported: PAIN IN EXTREMITY (non-serious) with onset 08Oct2023, outcome "unknown", described as "After receiving my Covid vaccine this past Saturday (07Oct2023). I had rap arm soreness."; AXILLARY MASS (non-serious) with onset 08Oct2023, outcome "not recovered", described as "I''ve now got a lump under my arm, in the armpit area"; CHILLS (non-serious) with onset 08Oct2023, outcome "unknown", described as "Started feeling chills". Therapeutic measures were taken as a result of pain in extremity, axillary mass, chills. Additional information: the patient specified that It formed a lump under her arms. It was actually a large lump, it''s now going down but it''s still there. Consumer stated, "I would be going to go the urgent care clinic, but I am figuring is, the shot because I didn''t have it and I put a warm compress on it. I have been taking like Ibuprofen, I took Tylenol earlier and I had to put like."


VAERS ID: 2715276 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Texas  
Vaccinated: 2023-11-09
Onset: 2023-11-10
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 8058081 / UNK RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944456 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fall, Pyrexia, Tinnitus
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Accidents and injuries (narrow), Hearing impairment (narrow), Vestibular 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: methotrexate, folic acid, leucovorin, atorvastatin
Current Illness: none
Preexisting Conditions: RA
Allergies: penicillin, sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: On the evening of 11-9-2023, I went in to store to get the updated Moderna Covid19 vaccine as well as my annual flu shot. My appointment was scheduled at 5pm. I received my vaccinations some time after my arrival as I had to check in, wait, pay, etc. My brother had come along with me to receive his updated vaccinations as well and he went first, then me. Exact time of my vaccination is unknown to me but was after 5pm and before 6pm. We went home and watched a movie and my right arm, which received the Covid19 injection was feeling sore. Next morning, 11-10-2023, I woke up around 7:30am and was getting out of bed to feed my cats. I nearly fell over as my body pulled to the left due to extreme dizziness. I tried to take a few steps toward my bedroom door but was so dizzy I had to lie back down in bed. I also had some fever, but the fever was not unexpected as it was how I reacted to previous Covid19 vaccinations; the extreme dizziness was another matter altogether. After lying there for a little while, I sat back up and waited for the spinning feeling to level off. I was still dizzy, but not falling over anymore, so I went to feed my cats and then laid back down and went back to sleep. Later in the day, I woke back up and was no longer dizzy but still had the slight fever. The following morning, 11-11-2023, I woke up with no dizziness and my fever was gone, but I now had a ringing, buzzing sound in both of my ears. I waited to file this report to see if the ringing would subside, but it has not as of now, 11-18-2023. The ringing is tolerable and not very noticeable to me when I am engaged in doing something such as talking to someone, shopping, watching a movie, etc., but becomes quite bothersome and prevalent when I am alone doing something quietly (reading, computer work, etc.) It is especially intrusive and loud when I am trying to fall asleep at night and is preventing me from falling to sleep well. I am hoping this situation somehow resolves itself in the future, but unfortunately for now I continue to have the ringing, buzzing sound in both of my ears.


VAERS ID: 2429691 (history)  
Form: Version 2.0  
Age: 2.0  
Sex: Female  
Location: Texas  
Vaccinated: 2022-09-02
Onset: 2022-09-03
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2022-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FT9142 / 1 LL / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 942401 / N/A RL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS LY35X / 2 RL / IM

Administered by: Private       Purchased by: ?
Symptoms: Febrile convulsion, Gaze palsy, Pyrexia, Tremor, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: Acute otitis media 8/3/22
Preexisting Conditions: history of PE tubes
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Had febrile seizure the day following vaccination at 5pm. Woke up with low grade fever from nap that afternoon, parents gave Tylenol. About an hour after that, became unresponsive, then arms shaking, eyes rolled back, Dad picked her up, couldn''t keep her alert. Entire event lasted about a minute. Dad blew in her face and that started to make her more responsive. Called EMS, who did vital signs that were normal. Parents took her to ER where diagnosis of febrile seizure was made (temp was 103-104) and pt. is back to baseline.


VAERS ID: 2724072 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Texas  
Vaccinated: 2023-10-28
Onset: 2023-11-14
   Days after vaccination: 17
Submitted: 0000-00-00
Entered: 2023-12-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 ON 7/26/ / 2 LA / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944487 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diplopia, Dizziness, Eyelid ptosis, Facial paralysis, Hypoaesthesia, Laboratory test, Lumbar puncture, Magnetic resonance imaging head, Magnetic resonance imaging spinal, Magnetic resonance imaging thoracic, Multiple sclerosis, Nystagmus
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Optic nerve disorders (broad), Demyelination (narrow), Hearing impairment (broad), Vestibular disorders (broad), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (narrow), Sexual dysfunction (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
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: Childhood Asthma
Allergies: Doxcycline up set stomach
Diagnostic Lab Data: MRI Brain, Cervical, Thoracic and Lumbar Puncture and multiple labs
CDC Split Type:

Write-up: On 10/28/2023, patient(18 yr ), received flu vaccine, about 2 weeks later, he c/o dizziness, double vision, numbness in feet, right eye and mouth droop that looked like bels palsy and left eye nystgamus. Took to doctor test were done and he was diagnosed on 12/6 with Multiple Sclerosis. Took Covid Vaccine at age 15. ( PREVIOUSLY SUBMITTED A REPORT FOR THE COVID VACCINE).


VAERS ID: 1795997 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Texas  
Vaccinated: 2021-10-18
Onset: 2021-10-18
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308469 / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaphylactic reaction
SMQs:, Anaphylactic reaction (narrow), Anaphylactic/anaphylactoid shock conditions (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: methotrexate, enbrel
Current Illness:
Preexisting Conditions: asthma, anemia, rheumatoid arthritis, crohn''s disease
Allergies: latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient experienced anaphylaxis around 20 minutes post vaccination with both moderna and flu vaccines. An epi pen was administered and patient was able to recover.


VAERS ID: 2689087 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Texas  
Vaccinated: 2023-09-30
Onset: 2023-09-30
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HB9835 / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. AU3129B / N/A RA / IM

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

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

Write-up: I went to the pharmacy to get the flu vaccine for school. I verbally stated I wanted to the flu vaccine twice, and was asked to fill out a consent form that asked what vaccine I wanted to get. I circled that I wanted the flu vaccine. I was then asked to wait in the waiting area to be called for the vaccine. The pharmacy tech opened the door and stated "Do you want the Pfizer or Moderna?" My fianc? and I looked at her confused because we didn''t know who the manufacturer for the flu vaccine was, so we asked her what she recommended. She stated "We do a lot of Pfizer here", so I said "then let''s go with that!" She leaves for a few minutes and then comes back and says she''d ready for me to enter the administration room. I don''t like needles, so I did not look at what she was doing. After I received the vaccine, I asked her for documentation to present to my school showing that I received the vaccine. She hands me the paper and I walked a few steps and saw on the paper that she wrote "Covid-19". I immediately went back to the counter and asked her if she gave me the covid vaccine instead of the flu shot. She said she gave me the covid vaccine because she thought that''s what I was there for. I explained that I only wanted the flu vaccine and never asked for the covid vaccine. I told her I needed the flu vaccine before tomorrow for school, so she said she would give me the flu vaccine and that I will be "fine" if I receive both vaccines in the same day. I let her administer the flu vaccine in the other arm because I had to have it for school by the next day, but I was very upset. I complained to the Pharmacist and the Store manager and they stated they would file incident reports.


VAERS ID: 2708245 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Texas  
Vaccinated: 2023-10-26
Onset: 2023-10-27
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AU3914B / N/A RA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / N/A RA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Brain fog, Fatigue, Muscle spasms
SMQs:, Dystonia (broad), Noninfectious encephalopathy/delirium (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: synthroid 150 mcg once in the morning trazadone 100 mg once at bedtime fluoxtine 10 mg once per day in the morning
Current Illness: none
Preexisting Conditions: hypothyroidism
Allergies: azithromycin erithromycin ciprofloxacin sulfa
Diagnostic Lab Data: none
CDC Split Type:

Write-up: brain fog, fatigue, constant muscle spasms in right eyelid and brow


VAERS ID: 1925033 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Texas  
Vaccinated: 2021-11-02
Onset: 2021-11-21
   Days after vaccination: 19
Submitted: 0000-00-00
Entered: 2021-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 1 LA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 309613 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Condition aggravated, Decreased appetite, Dizziness, Headache, Nausea, Paraesthesia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Buspirone 5mg, Ibuprofen 800mg, Tizanidine 4mg, Equate Complete multivitamin
Current Illness: Recovered from Covid
Preexisting Conditions: Anxiety and depression
Allergies: N/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: Persistent dizziness, persistent headache, nausea, loss of appetite, tingling in arms, increased anxiety. Consulted PCP, prescribed Sumatriptan for headache, scheduled for Neurology follow up.


VAERS ID: 2520540 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Texas  
Vaccinated: 2022-10-07
Onset: 2022-10-07
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH GJ2524 / 1 LA / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 348374 / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Balance disorder, Middle ear effusion, Off label use, Product use issue, Wrong product administered
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Hearing impairment (narrow), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), 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:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None, Comment: Other medical history: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202201335821

Write-up: major loss of balance; fluid build up in my right ear behind my eardrum; All joints in my whole body hurt for 6.5 weeks; Dose number:1/Brand:Pfizer CoVid Bival; vaccine received same date: Flucelvax Quad 2022-2023; vaccine received same date: Flucelvax Quad 2022-2023; This is a spontaneous report received from contactable reporter(s) (Consumer or other non HCP). The reporter is the patient. A 64-year-old female patient (not pregnant) received BNT162b2, BNT162b2 omi ba.4-5 (BNT162B2, BNT162B2 OMI BA.4-5), on 07Oct2022 at 10:00 as dose 1, single (Lot number: GJ2524) at the age of 64 years, in left arm for covid-19 immunisation; influenza vaccine inact sag 4v (FLUCELVAX QUAD), on 07Oct2022 as dose 1, single (Lot number: 348374) for immunisation. The patient didn''t receive BNT162b2 (BNT162B2). The patient had no relevant medical history. There were no concomitant medications. Past drug history included: Codeine, reaction(s): "Known allergies: Codeine". The following information was reported: OFF LABEL USE (non-serious), PRODUCT USE ISSUE (non-serious) all with onset 07Oct2022, outcome "unknown" and all described as "vaccine received same date: Flucelvax Quad 2022-2023"; WRONG PRODUCT ADMINISTERED (non-serious) with onset 07Oct2022 at 10:00, outcome "unknown", described as "Dose number:1/Brand:Pfizer CoVid Bival"; ARTHRALGIA (non-serious) with onset 07Oct2022 at 11:00, outcome "recovering", described as "All joints in my whole body hurt for 6.5 weeks"; MIDDLE EAR EFFUSION (non-serious) with onset 07Oct2022 at 11:00, outcome "recovering", described as "fluid build up in my right ear behind my eardrum"; BALANCE DISORDER (non-serious) with onset 07Oct2022 at 11:00, outcome "recovering", described as "major loss of balance". The events "major loss of balance", "fluid build up in my right ear behind my eardrum" and "all joints in my whole body hurt for 6.5 weeks" required physician office visit. Therapeutic measures were not taken as a result of balance disorder, middle ear effusion, arthralgia. Additional information: the patient did not receive any other vaccine in four weeks. The patient had not tested for COVID prior vaccination and post vaccination. The information on the batch/lot number for BNT162b2 has been requested and will be submitted if and when received.


VAERS ID: 2726862 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Female  
Location: Texas  
Vaccinated: 2023-12-22
Onset: 2023-12-22
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HM7010 / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 374869 / UNK LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Decreased appetite, 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: don''t know
Current Illness: don''t know
Preexisting Conditions: Don''t know
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Upon scanning the VAR, we noticed the sticker for the adult dose. Not sure if patient got Adult or Pediatric since there were multiple patients (1 adult and 2 pediatric). Followed up with patient''s mom and she says her child is not eating.


VAERS ID: 2689679 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Texas  
Vaccinated: 2023-09-28
Onset: 2023-10-01
   Days after vaccination: 3
Submitted: 0000-00-00
Entered: 2023-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 447595 / UNK LA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 314143 / N/A LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Peripheral swelling, Pruritus, Rash, Rash erythematous, Rash pruritic, Vaccination site 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 (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: potentially: escitalopram, ezetimibe, metformin, pregabalin, rosuvastatin, vascepa, zolpidem
Current Illness: unknown
Preexisting Conditions: urinary retention
Allergies: ciprofloxacin, tequin, vancomycin, quinolones
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: The patient reported that on the day of/after vaccination they experienced swelling of the arm around the vaccine site on the arm. On 10/1, after the shot was given on 09/28, the patient reported a rash starting on the left side of the face that progressed and grew larger across the face. It is red and itches, but there is no pain or blisters. The patient tried cetirizine/zyrtec and that did not alleviate any symptoms. The patient was counseled to report to their doctor and follow up. Patient said they would follow up if the situation worsened or did not improve over time. Benadryl was suggested as a nighttime option for itching, and an over the counter steroid cream for the daytime, no longer than x2 weeks, if the itching bothered the patient.


VAERS ID: 2699963 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Male  
Location: Texas  
Vaccinated: 2023-10-20
Onset: 2023-10-20
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 210F232A / UNK - / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944497 / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Dizziness, Fall, Head injury, Pallor, Resuscitation
SMQs:, Anticholinergic syndrome (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)

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

Write-up: The patient was receiving flu & COVID vaccines. He was dizzy and fell face forward & may have hit his head on side of door. He was pale. We called 911 and the CPR/paramedic team arrived. The patient was conscience. He was taken to hospital for further evaluation


VAERS ID: 2701299 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Texas  
Vaccinated: 2023-10-22
Onset: 2023-10-23
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HF9298 / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944486 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Oedema peripheral, Peripheral swelling
SMQs:, Cardiac failure (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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient stated on her left arm where she got the Covid vaccine, she had noticed a lot of swelling underneath her arm. Possibly her lymph nodes. She did not tell us if she had any major health conditions that may cause the swelling of her arm. The pharmacist recommended for the patient to follow-up with her doctor.


VAERS ID: 2709895 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Texas  
Vaccinated: 2023-11-01
Onset: 2023-11-02
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2023-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 4 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Hypoaesthesia, Laboratory test, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Sexual dysfunction (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: Omeprazole, Allegra, magnesium oxide, fish oil, probiotic, ibuprofen.
Current Illness: None
Preexisting Conditions: GERD, migraines, TMJ, seasonal allergies
Allergies: Gluten
Diagnostic Lab Data: Bloodwork. Not certain which labs were ordered.
CDC Split Type:

Write-up: I suddenly started having numbness and tingling in my right foot at around 4:00 pm on November 2. About 30 minutes later, I started having numbness and tingling in my right hand, with tingling going up my right forearm. About an hour later, I started having numbness and tingling in my left hand, with tingling going up my left forearm. I waited for about 3 hours to see if my symptoms would go away, but they did not. I took 600 mg of ibuprofen and 12.5 mg of Benadryl, and one hour afterward the numbness started to subsite in my right foot with the tingling in my right foot remaining. I went to sleep, and when I woke up the next day (November 3) all of the numbness/tingling in my right foot and my right hand had gone away. It was not until about 8:00 pm on November 3 that the numbness/tingling in my left hand went away. I went to my PCP today for a checkup related to this issue and they did labwork.


VAERS ID: 1939890 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Texas  
Vaccinated: 2021-12-10
Onset: 2021-12-10
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33030BD / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308496 / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, 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), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Patient came in for a Pfizer covid vaccine booster today and also received Flucelvax vaccine. The order was reviewed by precepting pharmacist, and vaccines were administered by intern. The patient was then sitting in the observation area when she started feeling weak and then started to lose consciousness. The mother quickly alerted the pharmacy staff and we rushed to assist patient. We paged code white over the intercom to alert management of the situation. We placed an ice pack behind patient''s neck and the patient immediately regained consciousness. We also provided them with some snacks and cold water in case the patient was feeling low on sugar. We took a blood pressure reading and the patient had a BP of 84/48 which could explain the syncopy. Market manager was immediately. Reassessed patient after 30 minutes and the blood pressure is now 97/84. The patient is alert and oriented to everything happening. The mother will drive patient home and will alert the pharmacy if anything else occurs.


VAERS ID: 1829356 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Texas  
Vaccinated: 2021-10-23
Onset: 2021-10-26
   Days after vaccination: 3
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Cardiac flutter, Electrocardiogram, Lymphadenopathy, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (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: Liothyroine, Synthnoid, Metformin ER, Emercen-C, Elderberry, Pepcid -?AC
Current Illness:
Preexisting Conditions: Diabetes, Hypothyroidism (surgically removed) , PCOS
Allergies: Codine, Penicillin, Mango
Diagnostic Lab Data: Waiting on EKG and bloodwork
CDC Split Type:

Write-up: I have fluttering and palpitations in my chest. I went to the doctor and they noticed swollen lymph nodes under my arm and I am awaiting EKG results


VAERS ID: 1768837 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Texas  
Vaccinated: 2010-10-06
Onset: 2021-10-06
   Days after vaccination: 4018
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 4 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308476 / 1 RA / IM

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

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

Write-up: Pt arrived to get her influenza vaccine and was given a 4 COVID vaccine. Patient reports feeling okay on the following day 10/7/21


VAERS ID: 2710200 (history)  
Form: Version 2.0  
Age: 2.0  
Sex: Female  
Location: Utah  
Vaccinated: 2023-10-24
Onset: 2023-10-24
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AU5558B / UNK LL / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944454 / UNK RL / IM

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

Write-up: Patient received 0.5ml of Covid Vaccine instead of the recommended 0.25ml for their age.


VAERS ID: 1906739 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Male  
Location: Utah  
Vaccinated: 2021-11-29
Onset: 2021-11-29
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 309617 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye pain, Inappropriate schedule of product administration, Ocular hyperaemia
SMQs:, Anaphylactic reaction (broad), Glaucoma (broad), 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: After receiving his 2 vaccinations, he went to play at a basketball game and his right eye became red and painful. It was red all around his eye and very painful. We recommended that he go to the instacare or ER to have it examined.


VAERS ID: 2710194 (history)  
Form: Version 2.0  
Age: 4.0  
Sex: Female  
Location: Utah  
Vaccinated: 2023-10-26
Onset: 2023-10-26
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AU5558B / UNK LL / IM
DTAPIPV: DTAP + IPV (QUADRACEL) / SANOFI PASTEUR U7656AA / UNK LL / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944454 / UNK LL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. X018575 / 2 LL / SC

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

Write-up: Patient received 0.5ml of Covid Vaccine instead of the recommended 0.25ml for their age.


VAERS ID: 2710186 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Male  
Location: Utah  
Vaccinated: 2023-10-24
Onset: 2023-10-24
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AU5558B / UNK LL / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370667 / UNK LL / IM

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

Write-up: Patient received 0.5ml of Covid Vaccine instead of recommended 0.25ml for their age.


VAERS ID: 2459734 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Utah  
Vaccinated: 2022-09-23
Onset: 2022-09-23
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033F / 5 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 942376 / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ear discomfort, Tinnitus
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: Tylenol PRN Ibuprofen PRN Vitamin C Daily Zinc Daily Vitamin D3 Daily Resveratrol Daily Montelukast Daily
Current Illness: None
Preexisting Conditions: Hx of childhood asthma that was aggravated by COVID19.
Allergies: Sulfa Cats
Diagnostic Lab Data: none
CDC Split Type:

Write-up: I began having a sensation of fullness in both ears, like a feeling of water was in my ears. It progressed to a humming and vibrating noise in my right ear and a vibrating noise in my left ear. Noises amplify the sounds more, making it worse. I am not sure if I need to go see a Dr about this or if it will resolve on it''s own.


VAERS ID: 2710171 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Male  
Location: Utah  
Vaccinated: 2023-10-26
Onset: 2023-10-26
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AU5558B / UNK LL / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 373546 / UNK RL / IM

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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: dexmethylphenidate 15mg
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient received 0.5ml of Covid Vaccine instead of recommended 0.25ml for his age.


VAERS ID: 1815386 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Virginia  
Vaccinated: 2021-10-01
Onset: 2021-10-02
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2021-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 LA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Chest pain, Echocardiogram, Electrocardiogram, Immunodeficiency, Laboratory test
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Velafaxine, singulair, zyrtec, pantoprazole, Vitamin D2
Current Illness: tooth pain
Preexisting Conditions: Vitamin D deficiency,
Allergies: Strong adhesives leave a mild rash
Diagnostic Lab Data: See above
CDC Split Type:

Write-up: October 2nd went to ER due to chest pains. Did an EKG which was fine. Chest xray was fine, labs were fine. Followed up with PCPs office October 4th and prescribed Tylenol with Codeine to help pain at night. Told it would last 10 days. October 22 followed up with my PCP who ordered another EKG (same results), blood work which showed high inflammation markers and ordered an echocardiogram. Haven''t had the echo yet. No improvements. Chest pain is constant with spikes of intensity.


VAERS ID: 1849149 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Virginia  
Vaccinated: 2021-11-04
Onset: 2021-11-05
   Days after vaccination: 1
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Injection site pain, Lymph node pain, Lymphadenopathy
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (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: On the same evening I received a flu shot in my right arm and the Pfizer booster in my left. I had already completed 2 rounds of pfizer vaccination in April of 2021. On Friday night I began having some tightness in my chest, and the injection site from the booster was extremely painful. When waking up ok Saturday morning I was still in a lot of pain and noticed the lymph nodes in my left armpit were severely swollen. The lymph nodes in the left side of my throat were also a bit swollen. The pain in my arm, chest, and lymph nodes has subsided a bit throughout Saturday, though I still have a significant lump under my arm.


VAERS ID: 1713577 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Virginia  
Vaccinated: 2021-09-18
Onset: 2021-09-18
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 2 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308433 / N/A LA / IM

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

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

Write-up: Patient experienced vasovagal syncope just minutes after receiving her second Pfizer Covid-19 vaccine and the seasonal influenza vaccine together. She was standing in our vaccine waiting area and fell hitting her head on the concrete floor, but did regain consciousness immediately. Emergency services was contacted immediately and they arrived 10 to 15 minutes later. The EMT examined her and felt it was not absolutely necessary she go to the emergency room as she remained alert and responsive. We told her mother signs and symptoms of concussion to be watchful for over the next 3 to 4 days and to report to the ER if her status changes.


VAERS ID: 1797704 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Virginia  
Vaccinated: 2021-10-15
Onset: 2021-10-15
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 3 LA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308433 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fatigue, Headache, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Vitamin D, Daily Multivitamin
Current Illness: Flu shot received at 11 AM same day as Pfizer Covid booster at 2 Pm
Preexisting Conditions:
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: About 4-5 hours after COVID booster (flu shot at 11 AM, COVID at 2:30) - nausea and dizziness started. Vomited multiple times with severe dizziness and nausea. No fever or below 99.5. Dizziness and vomiting continued through night from Oct 15 into mid-morning Oct 16. Symptoms alleviated on Sat Oct 16 afternoon through Sun afternoon. Then on Sunday evening (Oct 17th) dizziness returned and nausea and vomiting. These symptoms continued throughout night and into early morning of Oct 18. Symptoms alleviated at this time and now have mostly disappeared. Some slight nausea still felt as of Oct 19. Dull headache now and some fatigue.


VAERS ID: 2718080 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Virginia  
Vaccinated: 2023-11-24
Onset: 2023-11-24
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 80777-0102-93 / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 70461-0323-03 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injected limb mobility decreased, Pain in extremity, Product administered at inappropriate site
SMQs:, Drug abuse and dependence (broad), Tendinopathies and ligament disorders (broad), 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: Occasionally flovent & zyrtek for allergies
Current Illness: None
Preexisting Conditions: Well controlled asthma - no meds
Allergies: None
Diagnostic Lab Data: None at this point. It seems to be improving but I will seek medical care if improvement does not continue. I felt it was important to report ASAP.
CDC Split Type:

Write-up: Unable to move left arm beginning approx. 4-5 hours after injection. I mentioned that the injection was very high up on my arm to the pharmacist who did the injection. I had extremely limited mobility and intense pain in my left arm for the 32 hours. I had to use my right hand & arm to lift my left one. These vaccines were FAR TOO HIGH up on my arm.


VAERS ID: 2688946 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Virginia  
Vaccinated: 2023-09-27
Onset: 2023-09-29
   Days after vaccination: 2
Submitted: 0000-00-00
Entered: 2023-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 5 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Oral herpes
SMQs:, Oropharyngeal infections (narrow), Opportunistic infections (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, Claritin, fematodine
Current Illness:
Preexisting Conditions:
Allergies: Codein, Vicodin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Cold sore on lip


VAERS ID: 2714338 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Male  
Location: Virginia  
Vaccinated: 2023-11-15
Onset: 2023-11-15
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-11-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HE2391 / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370673 / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: mother mentioned pt had syncope prior. after AE
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: syncope post vaccination. hit head. called rescue


VAERS ID: 2697550 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Male  
Location: Virginia  
Vaccinated: 2023-10-17
Onset: 2023-10-17
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA AU5555B / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370657 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: nkda
Diagnostic Lab Data: pulse, blood pressure, oxygen were completed and were all with normal range - 10/17/23
CDC Split Type:

Write-up: Patient was administered both vaccines and then stood up then passed out and fell to the floor. EMS was called and all the child''s vitals came out normal. The parents choose to take their child home instead of taking him to the hospital.


VAERS ID: 2699723 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Female  
Location: Virginia  
Vaccinated: 2023-10-21
Onset: 2023-10-21
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HE2391 / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944486 / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Foaming at mouth, 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), Convulsions (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none that we are aware of
Current Illness: none that parent was aware of
Preexisting Conditions: none per mother
Allergies: NKDA per Vaccine Administration Record
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received covid vaccine and also flu vaccine and after a minute fainted and regained consciousness. Ambulance was called and patient was given glucose gel and then lost consciousness after a minute and was foaming at the mouth and then regained consciousness after a minute again. Ambulance came and took vitals, which were stable and then she went with the ambulance


VAERS ID: 2700824 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Virginia  
Vaccinated: 2023-10-19
Onset: 2023-10-19
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3030592 / N/A RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370652 / N/A RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Vertigo
SMQs:, Vestibular disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: vertigo following previous COVID-19 booster (Pfizer bivalent booster administered 9/30/22)
Other Medications: escitalopram 10 mg
Current Illness: N/A
Preexisting Conditions: Asthma
Allergies: latex
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Vertigo starting same day as vaccine administration, intermittent from 10/19-10/23


VAERS ID: 2729580 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Vermont  
Vaccinated: 2023-12-20
Onset: 2023-12-20
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2024-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3031416 / 5 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944451 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blister, Blister infected, Blister rupture, Immediate post-injection reaction, Vaccination site rash
SMQs:, Severe cutaneous adverse reactions (broad), Hypersensitivity (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: gabapentin, escitalopram, epi pen (PRN allergic reaction)
Current Illness: n/a
Preexisting Conditions: CRPS, PNES
Allergies: cephalosporins, tree nuts
Diagnostic Lab Data:
CDC Split Type:

Write-up: vaccination area had immediate rash. Blister appeared appx 3 days after date of vaccine. Blister popped c. 12/30/2023 and becameinfected- today is the worst that the infection has been. Primary care has not given any antibiotics as of this reporting


VAERS ID: 2317423 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Vermont  
Vaccinated: 2021-11-11
Onset: 2021-11-20
   Days after vaccination: 9
Submitted: 0000-00-00
Entered: 2022-06-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039F21A / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308485 / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Autopsy, Death, Exercise lack of, Fatigue, Malaise, Pulmonary embolism, Respiratory disorder, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-21
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Possibly Topiramate, Sertraline hydrochloride, Clonazepam, Desogestrel; ethinyl estradiol
Current Illness: unknown
Preexisting Conditions: migraines, anxiety
Allergies: unknown
Diagnostic Lab Data: autopsy
CDC Split Type:

Write-up: Decedent was reportedly feeling unwell with respiratory complaints for several days to week prior to death, progressively became more ?wiped out? and tired, staying in bed most of the time. She was found unresponsive in the bathroom where she was pronounced dead by EMS. Autopsy confirmed bilateral pulmonary thromboemboli as cause of death, with multiple risk factors including obesity (BMI 46.9), recently sedentary, COVID-19 and Influenza vaccinations, and Desogestrel/ethinyl estradiol


VAERS ID: 2473890 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Washington  
Vaccinated: 1961-07-31
Onset: 2022-10-10
   Days after vaccination: 22351
Submitted: 0000-00-00
Entered: 2022-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 057A22A / 4 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 348372 / N/A LA / IM

Administered by: Private       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: Dulaglutide (TRULICITY) 0.75 MG/0.5ML pen-injector solution AmLODIPine 5 MG tablet Cholecalciferol (VITAMIN D-3) 25 MCG (1000 UT) capsule Insulin Lispro (1 Unit Dial) (HumaLOG KwikPen) 100 UNIT/ML pen-injector solution Insulin Pen Needle (B
Current Illness: NA
Preexisting Conditions: DM2, asthma, HTN, CKD
Allergies: penicillins
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: patient was supposed to receive the Moderna BIVALENT vaccine and received the Moderna MONOVALENT vaccine instead.


VAERS ID: 2192401 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Male  
Location: Washington  
Vaccinated: 2022-01-01
Onset: 2022-01-01
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 - / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 2493G / N/A LL / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. U024094 / 1 LL / IM

Administered by: Military       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: Event: Pediatric Pfizer Vaccine Lot Number FK5127, was improperly stored in an Immunizations Freezer that maintained a temperature between -15 Celsius and -24 Celsius. Per the Manufacture?s guidelines the vaccine must be stored in a Refrigerator maintaining temperature of 2-8 Degrees Celsius or an Ultra-Low Cold Freezer maintaining temperature of -90C or lower. The patient received the vaccine that was improperly stored. Treatment: Not required, patient did not report any adverse reactions to the Vaccine. Outcome: Patient?s guardian notified and offered to restart the Pediatric Pfizer Covid Vaccine series again stored at the proper temperature. Signs, Symptoms course, etc. None reported by the patient?s guardian


VAERS ID: 2130310 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Washington  
Vaccinated: 2022-02-19
Onset: 2022-02-19
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Asthenia, Chills, Dyspnoea, Myalgia, Nausea, Pain, Rhinorrhoea, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament 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: cold,sore throat, chills
Preexisting Conditions: COPD
Allergies: latex, but none was used when i got vacinnated
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: right after the shots about 15 minutes later i was dropping things on the floor and spilling things over. Then At 9:00pm Feb.19, 2022 until 3:00am the next day within the time frame i was having a stomach ache, chills,muscle pains in my legs, nauseated and throwing up. hard to breathe sometimes i needed to raise the back of the bed to prop my head up for easy breathing. After throwing up many times i was able to fall asleep. now on Feb.20,2022 i feel much better just have a right side ache and runny nose now.


VAERS ID: 2499967 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Washington  
Vaccinated: 2022-11-02
Onset: 0000-00-00
Submitted: 0000-00-00
Entered: 2022-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FP7141 / 4 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 351711 / N/A RA / IM

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

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

Write-up: Patient was given the monovalent Pfizer vaccine rather than the intended bivalent Pfizer vaccine booster.


VAERS ID: 2099745 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Washington  
Vaccinated: 2022-01-07
Onset: 0000-00-00
Submitted: 0000-00-00
Entered: 2022-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD7218 / UNK LA / IM
DT: DT ADSORBED (NO BRAND NAME) / SANOFI PASTEUR U7092AA / UNK RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 309618 / UNK RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injected limb mobility decreased, Insomnia, Migraine, Pain, Pain in extremity
SMQs:, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe left arm pain. After receiving injections patient''s arm sore. Instead of soreness improving, soreness worsened. No onset date of symptoms. severe pain, unable to lift left arm, difficultly sleeping, migraines. Patient has been seen at medical office and ER for symptoms. Latest ER visit 2/9/22. patient believes she is having a reaction to the TD vaccine.


VAERS ID: 1861864 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Washington  
Vaccinated: 2021-09-27
Onset: 2021-09-27
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308437 / UNK RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dose administered, Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multiple, n/a- reporting administration error
Current Illness:
Preexisting Conditions: Psoriasis, heart disease, Type 2 Diabetes,
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Administer 0.5ml dose to the patient instead of the indicated 0.3mL dose. Patient noted typical injection site pain and swelling, perhaps more pain the previous. No residual symptoms.


VAERS ID: 2700888 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Washington  
Vaccinated: 2023-10-21
Onset: 2023-10-21
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / N/A RA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / N/A RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal distension, Headache, Heart rate increased, Intermenstrual bleeding, Menstruation irregular, Muscle spasms, Myalgia, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Fertility disorders (broad), Tendinopathies and ligament disorders (broad), 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: Covid 19 vaccine, Pfizer and Johnson & Johnson
Other Medications: Microgestin FE 1/20 birth control
Current Illness:
Preexisting Conditions:
Allergies: Oral allergy syndrome - ragweed and white pine.
Diagnostic Lab Data:
CDC Split Type:

Write-up: irregular period/breakthrough bleeding, cramps, bloating, high fever, high heart rate, muscle aches and pain, nausea, headache,


VAERS ID: 2704589 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Washington  
Vaccinated: 2023-10-27
Onset: 2023-10-27
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 4 - / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Anaphylactic reaction, Asthenia, Blood test, Chest X-ray, Dizziness, Dysarthria, Electrocardiogram, Urine analysis
SMQs:, Anaphylactic reaction (narrow), Anticholinergic syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Vestibular disorders (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin, Lisinopril, citalipram, cocyntx, and hydrochlorothiazide
Current Illness: None
Preexisting Conditions: Psoriatic arthritis, psoriasis, and prediabetes
Allergies: Watermelon
Diagnostic Lab Data: Ekg, urinalysis, blood work, chest X-ray
CDC Split Type:

Write-up: Dizziness, weakness, slurred speech, anaphylaxis


VAERS ID: 1989453 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Washington  
Vaccinated: 2021-12-29
Onset: 2021-12-29
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 069H21A / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308476 / N/A RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient received his 1st Moderna COVID on 05/28/2021 and his second Moderna vaaccine on 08/09/2021. I administered a Moderna Booster 0.25 ml approximately one monthe early. there was no adverse events. patient agreed to call the clinic w
Current Illness: none
Preexisting Conditions: Asthma, Hypertension, hyperlipidemia, and hypothyroidism
Allergies: Amitriptalyne and Penicillin
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient received his Moderna Booster 0.25 ml approximately 1 month early. First Moderna given on 05-28-2021, second Moderna given on 08/09/2021 and Moderna Booster given 12/29/2021. Patient notified of the error and has agreed to report to the clinic any adverse reactions.


VAERS ID: 2473878 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Washington  
Vaccinated: 2022-10-10
Onset: 2022-10-10
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 057A22A / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 348361 / N/A RA / IM
PNC20: PNEUMO (PREVNAR20) / PFIZER/WYETH FW6028 / N/A RL / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS 9ZK5T / N/A LA / -

Administered by: Private       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: Novolog, Jardiance, Allopurinol, Ezetemibe, torsemide, basaglar, atorvastatin, spironolactone, gabapentin
Current Illness: No
Preexisting Conditions: DM2, HTN, h/o NSTEMI
Allergies: erythromycin, almond oil
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Patient was supposed to received Moderna BIVALENT vaccine and received Moderna MONOVALENT instead.


VAERS ID: 2473872 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Washington  
Vaccinated: 2022-10-10
Onset: 2022-10-10
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 057A22A / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 348361 / N/A LA / IM
PNC20: PNEUMO (PREVNAR20) / PFIZER/WYETH FW6028 / N/A RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS 9ZK5T / N/A RA / IM

Administered by: Private       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: Metronidazole , tylenol, multivitamin
Current Illness: None
Preexisting Conditions: H/o Leg cancer
Allergies: None
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Patient was supposed to receive the Moderna BIVALENT vaccine. The incorrect vaccine was drawn up and patient received the Moderna MONOVALENT vaccine.


VAERS ID: 2463211 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Washington  
Vaccinated: 2022-09-15
Onset: 2022-09-15
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FP7141 / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 348364 / 1 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? 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: incorrect pfizer covid 19 vaccine administered - should have been pfizer covid 19 bivalent vaccine


VAERS ID: 1741972 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Washington  
Vaccinated: 2021-09-28
Onset: 2021-09-28
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308462 / N/A RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Dizziness, Extra dose administered, Interchange of vaccine products, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), 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: Pt received first 2 COVID vaccines from moderna. Pt received Pfizer booster. Pt @10min mark reported light-headedness, gave water. Reported nausea at 30min mark symptoms improved.


VAERS ID: 2713296 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Washington  
Vaccinated: 2023-11-13
Onset: 2023-11-13
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 5 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370919 / UNK RA / IM
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER LOT#: MV089E3 / N/A LA / IM

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

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

Write-up: After administration of the Spikevax, the final injection, the patient had syncopal episode and lost consciousness for a brief time.


VAERS ID: 2461152 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Washington  
Vaccinated: 2022-09-15
Onset: 2022-09-15
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FP7141 / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 348364 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect product formulation administered, Wrong 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: incorrect pfizer covid 19 vaccine administered - should have been pfizer covid 19 bivalent vaccine


VAERS ID: 2718035 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Washington  
Vaccinated: 2023-11-26
Onset: 2023-11-26
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3031900 / 4 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370648 / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, Somnolence, 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), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: After receiving shot, patient mentioned that he felt sleepy. Patient rested his head on his arms on the table in the vaccine room. Later he body drooped and patient was unconscious. Pharmacist caught the patient body and laid the patient on the floor, using the patient''s jacket as a pillow. Momentarily later, the patient regain consciousness and asked what happened. It was explained to the patient that he fainted and this is not medical emergency. Patient remaining laying on the floor until they felt comfortable to stand up. Patient was asked if he had any head injury and patient remarked that his head felt fine. Patient then said he will leave with his girlfriend and his girlfriend will help him if anything else occur.


VAERS ID: 2461136 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Washington  
Vaccinated: 2022-09-14
Onset: 2022-09-14
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FP7141 / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 348364 / 1 RA / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS 7B2YL / UNK 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? 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: incorrect pfizer covid 19 vaccine administered - should have been pfizer covid 19 bivalent vaccine


VAERS ID: 2460847 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Washington  
Vaccinated: 2022-09-15
Onset: 2022-09-15
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FP7141 / 1 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 348364 / 1 LA / IM

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

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

Write-up: Incorrect Pfizer vaccine given.


VAERS ID: 2043786 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Wisconsin  
Vaccinated: 2022-01-18
Onset: 2022-01-18
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3209 / UNK LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308489 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HydrOXYzine HCl 25mg Tablet Sertraline 100mg Tablet
Current Illness: Depression and anxiety
Preexisting Conditions: Tobacco abuse
Allergies: NKA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient was given an additional dose of the flu vaccine. Received his last one on 10/13/2021. No adverse reactions.


VAERS ID: 2443944 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Wisconsin  
Vaccinated: 2022-09-09
Onset: 2022-09-01
Submitted: 0000-00-00
Entered: 2022-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH GLT9694 / 5 UN / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / UNK UN / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling abnormal, Hypersomnia, Pain
SMQs:, Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Nerlynx, Amlodipine, Lisinopril, metoprolol, fiber capsules, Vitamin D3, baby aspirin, vitamin C, pravastatin, biotin, coQ10, Venlafaxine
Current Illness: None
Preexisting Conditions: Heart disease, linear scleroderma, breast cancer survivor still taking treatment, high cholesterol, high blood pressure
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I woke up the next morning from when I was vaccinated and I felt like I was hit by a truck. I had body aches all over my body, it hurt to move. I slept all day.


VAERS ID: 2600309 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Wisconsin  
Vaccinated: 2021-11-05
Onset: 2021-11-01
Submitted: 0000-00-00
Entered: 2023-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Blood follicle stimulating hormone increased, Hot flush, Menstruation irregular
SMQs:, Fertility 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: None
Preexisting Conditions: Alpha 1 antitripysin deficiency carrier Chronic tension headaches Hypermobile ehlers danlos syndrome OSA migraine POTS
Allergies: Amoxicillin, Benzoyl peroxide, cefuroxime, sulfa
Diagnostic Lab Data: FSH 37.6 on 10/6/2022
CDC Split Type:

Write-up: Patient''s menstrual periods stopped for 4 months then became irregular associated with hot flashes and elevated FSH


VAERS ID: 2162774 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Wisconsin  
Vaccinated: 2022-03-06
Onset: 2022-03-06
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2022-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK9895 / 3 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308465 / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Head injury, Immediate post-injection reaction, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), 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: Mentioned feeling queezy around needles.
Other Medications: No known medications.
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: No known allergies.
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient fainted after getting up right after receiving 2nd vaccination. He hit his head on the wall on his way down and I was unable to catch him since he was 6'' - 220 lbs+.


VAERS ID: 2689234 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Wisconsin  
Vaccinated: 2023-10-01
Onset: 2023-10-01
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HD9876 / 5 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 370657 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Dizziness, Loss of consciousness, Musculoskeletal stiffness, Nausea, Syncope, Tension, Unresponsive to stimuli, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Arthritis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: unknown what he was given but he mentioned this happened about 10 years ago
Other Medications: No prescriptions taken but he did get a flu vaccine (Flucelvax) right before hand in the same arm at least one inch apart. He was fine after the flu shot.
Current Illness: none known
Preexisting Conditions: None reported
Allergies: none reported
Diagnostic Lab Data: No medical tests were performed.
CDC Split Type:

Write-up: Pt got the first shot, the flu shot in the left deltoid and was fine after that shot. He requested that the updated covid shot, Comirnaty, be given in the same arm. After giving the shot in the same arm, at least 1 inch apart from other shot, pt stated he was getting dizzy while sitting there. Immediately after, he passed out in the chair and his body started to freeze/tense up. I hesitate to call it a seizure but he was unresponsive for a good 20 to 30 seconds. I held him in place so that he wouldn''t fall or hit his head. I tried to bring him around by calling his name. He didn''t respond so I called to my tech to call 911. By the time the tech picked up the phone, patient was responding to me and I explained what happened as he was confused. He stated he was very nauseous and dizzy. I asked him easy questions to keep him talking and to gauge his responses. There was no slurring of speech and no abnormal movements after he came back. He refused the 911 call. I asked him if there was anyone he could call to come sit with him and monitor him for a while after he left. He called his fiance to come and pick him up. He did admit that about 10 years ago he had a similar reaction to getting a shot for an MRI. He stated that he had passed out and seized on the nurse that was helping him then. I told him not to get 2 shots at once anymore and to report the dizziness and fainting on his VAR in the future as he did not with us. He did end up vomiting a bit in our garbage can before he left. He also admitted that he did eat breakfast this morning. I did suggest that he follow up with his MD due to this incident.


VAERS ID: 2705672 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Wisconsin  
Vaccinated: 2023-10-27
Onset: 2023-10-27
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 80777-0102-96 / N/A RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 70461-0323-03 / N/A RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site discomfort, Injection site erythema, Injection site mass
SMQs:, 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: Lamotrigine
Current Illness: none
Preexisting Conditions: epilepsy
Allergies: None
Diagnostic Lab Data: None, self monitoring. Have not reached out to provider since it seems to be improving. If worsens today, will call. Too soon to say I have recovered.
CDC Split Type:

Write-up: Redness and lump at site of vaccinations. Redness and lump progressively worsened over the first 24 hours noticed about 5 hours after injections. Firm lump in area of vaccines approximately 1.5 inches circular. redness approximately 3 inches circular. In second 24 hours, redness expanded on 1 side of circle by approximately 1/2 inch. Significant discomfort in the arm at injection sites but I expected this. Checked this morning and it looks like the redness has stopped spreading and lump may be smaller. I have it marked to watch for worsening symptoms.


VAERS ID: 1984619 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Wisconsin  
Vaccinated: 2021-12-06
Onset: 2021-12-06
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3197 / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308489 / N/A RA / IM

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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Acetaminophen (Tylenol Extra Strength?) 500mg Tablet Sig: 2 Tablet(s) (1,000 mg) by mouth as needed AmLODIPine 5mg Tablet Sig: 1 Tablet(s) (5 mg) by mouth once daily for high blood pressure Aspirin 81mg Tablet, Delayed R
Current Illness: Covid + with monoclonal infusion 10 days prior (this is the error identified)
Preexisting Conditions: Postherpetic neuralgia. Non-insulin-dependent type 2 diabetes Hyperlipidemia Hypertension Chronic low back pain Mild obesity Major chronic recurrent depression Trigger finger involving multiple fingers of the right hand Chronic kidney disease stage III and diabetes
Allergies: Lisinopril, Latex
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Patient had received monoclonal antibodies 10 days prior to Pfizer booster.


VAERS ID: 2709698 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Wisconsin  
Vaccinated: 2023-11-03
Onset: 2023-11-03
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944466 / UNK LA / IM
RSV: RSV (ABRYSVO) / PFIZER/WYETH HH1818 / N/A RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Accidental exposure to product, Maternal exposure before pregnancy
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Medication errors (narrow)

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

Write-up: RSV was given inadvertently vaccinator thought patient fell in the 32-36 week category of eligibility so ABRYSVO was given in addition to the covid and flu shot. Spoke to patient and they were not wanting to escalate any further so reporting due diligence


VAERS ID: 2710181 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Wisconsin  
Vaccinated: 2023-10-26
Onset: 2023-10-30
   Days after vaccination: 4
Submitted: 0000-00-00
Entered: 2023-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3032233 / N/A LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944488 / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bundle branch block right, Electrocardiogram abnormal, Electrocardiogram ambulatory, Feeling abnormal, Palpitations, Sinus rhythm
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Dementia (broad), Cardiomyopathy (broad), Noninfectious myocarditis/pericarditis (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: Clindamycin topical gel Zyrtec
Current Illness: None
Preexisting Conditions: Successful catheter ablation procedure in 2009 to correct heart arrhythmia. Procedure effectively "cured" the arrhythmia.
Allergies: Penicillin
Diagnostic Lab Data: I visited my doctor that same day, 10/30/2023, and he ordered an EKG. It came back as normal sinus rhythm, incomplete right bundle branch block, borderline ECG. A Holter monitor was fitted on 11/2/2023, and I will wear it until 11/9/2023. I have continued to feel palpitations during this period of wearing the monitor but have not experienced a racing heartbeat since the initial episode. I should note that prior to these vaccines administered on 10/26/2023, I did not have any significant issues with heart palpitations or racing heart.
CDC Split Type:

Write-up: Shortly after midnight on 10/30/2023, while brushing my teeth before bed, I experienced a series of heart palpitations that went on for 20-30 seconds. It felt as though my heart would not return to a normal rhythm. Following the palpitations, my heart started racing incredibly fast. It was such an odd, unsettling feeling that I woke my wife up. My heart raced for about 4-5 minutes, at which point my wife found our blood pressure monitor. By the time I put the monitor on, my heart rate dropped to about 99 bpm, and my blood pressure was around 133 over 72.


VAERS ID: 2713229 (history)  
Form: Version 2.0  
Age: 2.0  
Sex: Male  
Location: Wisconsin  
Vaccinated: 2023-10-18
Onset: 2023-10-18
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HH3252 / 4 LL / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 373068 / 1 RL / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dose administered, Product preparation 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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Child was accidently given the whole undiluted vial of Covid Pfizer vaccine age 6 mos to 4 years


VAERS ID: 2714550 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Wisconsin  
Vaccinated: 2023-11-15
Onset: 2023-11-15
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 4 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Headache, Hypoaesthesia, Musculoskeletal stiffness, Pain, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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: ambien. chlonazapen, armodifanal
Current Illness: n/a
Preexisting Conditions: delayed sleep syndrome
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: generalized body pai, fever, chills, headache, neck stiffness, numbness in gingertips


VAERS ID: 2720398 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Wisconsin  
Vaccinated: 2023-11-29
Onset: 2023-12-02
   Days after vaccination: 3
Submitted: 0000-00-00
Entered: 2023-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HG2282 / N/A LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944494 / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Mobility decreased, Pain in extremity, Vaccination site bruising
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Parkinson-like events (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: Patient''s arm is very sore and she unable to lift or move it. I checked the vaccination site and there is bruising the size of a dime. It does not appear that the shot was administered too high (shot administered approximately 2-3 inches below shoulder).


VAERS ID: 2690958 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: West Virginia  
Vaccinated: 2023-10-04
Onset: 2023-10-04
   Days after vaccination: 0
Submitted: 0000-00-00
Entered: 2023-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HF9275 / 1 LA / ID
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 944459 / N/A RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Depressed level of consciousness, Disorientation, Seizure
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: MAG64 QD DULOXETINE 60MG QD LOSARTAN 100MG QD LORATADINE 10MG QD XANAX 0.5MG TID PRN SIMVASTATIN 20MG QD METOPROLOL SUCCINATE 50MG QD PRILOSEC 40MG QD ANORO ELLIPTA 1 PUFF QD VENTOLIN HFA PRN GABAPENTIN 300 BID PRN CYCLOBENZAPRINE 10MG (1
Current Illness: UNKNOWN, PT SEEMED NORMAL AT TIME OF VACCINATION
Preexisting Conditions: UNKNOWN
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received the flu shot and Comirnaty (23-24) shot simultaneously (flu shot in right arm and covid in the left). He seemed fine at the time of vaccination, was joking and talk to me. About 10- 15 minutes later someone came up to the pharmacy and stated that there was a medical emergency in one of the aisles. Patient was lying on the floor, breathing and semi-conscious. He evidently had had a seizure (evidenced by foam around his mouth and his disorientation). Paramedics arrived shortly after and took him away. No updates currently.


VAERS ID: 2732509 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: West Virginia  
Vaccinated: 2023-10-13
Onset: 2023-12-26
   Days after vaccination: 74
Submitted: 0000-00-00
Entered: 2024-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Neurological symptom
SMQs:

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin 81mg, cabenuva, latanoprost ophthalmic, brimonidine ophthalmic
Current Illness: No
Preexisting Conditions: HIV
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient developed signs of stroke, was treated while hospitalized, and has since recovered


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