Found 4,213 cases where Age is 0.5-or-more-and-under-5 and Vaccine is COVID19 and Vaccination Date on/after '2022-06-01'

Administered by: Public       Purchased by: ?
Symptoms: Product administered to patient of inappropriate age, Product administration 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: Client received Pfizer COVID-19 vaccine for 5-11 yr olds. Client is only 4 years old. Parent was informed at the time the error occurred.

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vit D and EPIPEN JR prescribed
Current Illness: Tested for food allergies
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient was given a dose of 0.2 ml out of a vial that had not been diluted

Administered by: Private       Purchased by: ?
Symptoms: Brief resolved unexplained event, Cardiac monitoring normal, Electrocardiogram normal, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Neonatal disorders (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? Yes, 1 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vitamin d
Current Illness: 2-3 weeks prior he had a slight runny nose. Negative rapid tests (took tests over the course of three days - the entire family). Dad took a negative PCR.
Preexisting Conditions: None.
Allergies: None
Diagnostic Lab Data: EKG 6/30 - Normal O2 sat and HR monitor overnight with admission 6/30-7/1. Normal overnight.
CDC Split Type:

Write-up: 24 hours post-vaccine baby had a BRUE. While changing his diaper he went unresponsive and I questioned if he was breathing. I startled him back with shouting his name. He then became unresponsive again. This occurred 4-5 times over 1-2 minutes. I attempted startling and tryingg go to get a reaction and he became alert again. I took him to the ER where he was diagnosed as having a BRUE and was kept on monitors overnight.

Administered by: Other       Purchased by: ?
Symptoms: Induration, Injection site erythema, Injection site reaction, Injection site swelling, Pain in extremity, Skin exfoliation, Skin warm
SMQs:, Severe cutaneous adverse reactions (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Hiya Multivitamin; Nova Ferrum Liquid Iron Supplement
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type: vsafe

Write-up: He said his arm was hurting. I took off his shirt to look and it was warm to the touch. It was really red, swollen, and hard. I put come ice on it and called the doctor. He said it felt better after we applied the ice and he took a nap like normal. once we talked to the doctor, it got redder that day. It was very bright beet red. The hole where the injection was now visible. It was super red around it. Before it was flat, then it was swollen and visible. The doctor told me to outline it to track if it was infected or not. It did spread outside of that line, but the redness went down as I was icing it. She told me to give him Benadryl at night before bed to see if that helped then Zyrtec during the day. She said to call back if it did not become better. In the morning, I called again because it spread outside of the original line. The first day it was really red and bright looking. The next day it was bigger but lighter and less angry looking. The nurse told me to give him some Zyrtec and to keep icing and watching it. She saw the pictures and said it did look better. She said to call back again if it doesn''t continue getting better. IT?s gotten better each day and there is a faint spot where it was. It?s faintly red and the skin is peeling a little bit around the injection site.

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: no tests needed no adverse events seen
CDC Split Type:

Write-up: the patient took the Pfizer dose of pediatrics instead of the toddler dose but the mother gave the incorrect date of birth of the patient. The patient''s actual age was 4 at the time of the vaccine administration of their first Pfizer dose. The patient was notified that the wrong dose was given to them, but they were aware that they gave the incorrect date of birth of the child. This was discovered on 7/7/22 when the father returned for the child''s second dose.

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Hypersomnia, Hypophagia, Influenza A virus test negative, Influenza B virus test, Pyrexia, SARS-CoV-2 test negative, Streptococcus test negative
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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), 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 with flouride
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: 07/08/22 -Streptococcus group A RNA: Negative -Influenza virus A + B + SAR-Cov-2 (COVID 19) Ag panel, rapid IA, upper respiratory specimen: Negative
CDC Split Type:

Write-up: Patient developed a 102.1 fever at around 6:30 am on 07/08/2022. She was tired throughout the day, slept more than she typically does, and did not eat much at meals.

Administered by: Private       Purchased by: ?
Symptoms: Decreased appetite, Fatigue, Irritability, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, fatigue, loss of appetite, fussy, in pain-achy

Administered by: Private       Purchased by: ?
Symptoms: Circumstance or information capable of leading to medication error, Product administered to patient of inappropriate age, 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
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: When I was drawing up 4 year vaccine . The Assistant of that doctor in which i was helping with vaccine, told me to do COVID VACCINE to another Room Also. I misheard and understood they were 7 years old. I drew up 5-11 PFIZER vaccine instead of 6month- 4 years MODERNA vaccine and administered to 4 year old patient.

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

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

Write-up: When I was drawing up 4 year vaccine . The Assistant of that doctor in which i was helping with vaccine, told me to do COVID VACCINE to another Room Also. I misheard and understood they were 7 years old. I drew up 5-11 PFIZER vaccine instead of 6month- 4 years MODERNA vaccine and administered to 4 year old patient.

Administered by: Work       Purchased by: ?
Symptoms: Blood glucose normal, Cardiac monitoring, Crying, Decreased appetite, Eye movement disorder, Fatigue, Muscle rigidity, Pyrexia, Skin discolouration
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (narrow), Depression (excl suicide and self injury) (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None. Covid 5 weeks ago
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: EMS measured blood pressure, temperature, blood sugar, and put some leads on his body to monitor his heart. ED measured temperature, O2 level, and heart rate.
CDC Split Type:

Write-up: Woke up after nap very tired. Cried getting diaper changed. Refused snack/drink. Started to fall, eyes rolled back, skin tone looked gray/blue, body went rigid for about 2 minutes. EMS arrived within 10 min. HR at 180 bpm. Febrile 102F. Blood sugar 112 mg/dL

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

Write-up: Incorrect dosage of mRNA COVID-19 vaccine product was inadvertently administered. Patient received Moderna 100 ?g 0.5 ml age not indicated

Administered by: Private       Purchased by: ?
Symptoms: Body temperature, Product administered at inappropriate site, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug abuse and dependence (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? Yes
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: Patient''s Medical History (including any illness at time of vaccination): None
Allergies:
Diagnostic Lab Data: Test Date: 20220701; Test Name: fever; Result Unstructured Data: Test Result:gone down; Comments: almost 105 degrees to 102 degrees
CDC Split Type: USPFIZER INC202200920318

Write-up: prolonged high fever; Anatomical Location of Administration of Pfizer vaccine considered as suspect: Left Thigh; This is a spontaneous report received from contactable reporter(s) (Pharmacist) from medical information team. The reporter is the parent. A 13-month-old female patient received BNT162b2 (BNT162B2), on 23Jun2022 at 11:45 as dose 1, single (Lot number: FT9142) at the age of 13 months, in left thigh for covid-19 immunisation. The patient had no relevant medical history. There were no concomitant medications. Vaccination history included: mmr, administration date: 05May2022, when the patient was 12-month-old, for Immunisation, reaction(s): "Diarrhea". The following information was reported: PRODUCT ADMINISTERED AT INAPPROPRIATE SITE (non-serious) with onset 23Jun2022 at 11:45, outcome "unknown", described as "Anatomical Location of Administration of Pfizer vaccine considered as suspect: Left Thigh"; PYREXIA (medically significant) with onset 25Jun2022, outcome "not recovered", described as "prolonged high fever". The event "prolonged high fever" required emergency room visit. The patient underwent the following laboratory tests and procedures: Body temperature: (01Jul2022) gone down, notes: almost 105 degrees to 102 degrees. The patient did not receive any other vaccines within four weeks prior to the vaccination. History of all previous immunization with the Pfizer vaccine considered as suspect (or patient age at first and subsequent immunizations if dates of birth or immunizations are not available)was none reported.; Sender''s Comments: Based on the information in the case report and a plausible temporal relationship, a possible causal association between the events and suspect drug BNT162B2 cannot be excluded. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.

Administered by: Public       Purchased by: ?
Symptoms: Chills, Diarrhoea, Pain
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

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

Write-up: She developed pain, diarrhea, chills, and temperature of 100.4

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose, Cold sweat, Cough, Heart rate decreased, Hypotonia, Pallor
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (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: Citirizine Multi vit
Current Illness: none
Preexisting Conditions: none
Allergies: Animal Dander Peanut Sesame Seed
Diagnostic Lab Data: BP''s/P/Glucose
CDC Split Type:

Write-up: Child waiting with dad after vaccination. After 15min, father states that child coughed and started calling out and slowing falling over. No loss of consciousness. Father alerted staff. They were brought to a patient room. Doctort was alerted and was in the room with child. Child very pale. Skin cool and clammy. Decreased heart rate to 59 and blood pressure was 72/38. Glucose was 89. Blood pressure retaken after 5 min. (72/36) Pulse was 72. Color slowly returned to his face. Cool water and cookies given. Child eating and drinking. Father states, "He looks much better." Episode lasted approximately 15 min.

Administered by: Private       Purchased by: ?
Symptoms: Peripheral swelling, Rash erythematous, Vaccination site rash, Vaccination site reaction
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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None needed
CDC Split Type:

Write-up: Large red rash around vaccination site 8 days after vaccine was given. Also a little swollen.

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: History of tetralogy of fallot s/p repair
Allergies: None known
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Whole body rash occuring 48-72 hours after vaccination.

Administered by: Other       Purchased by: ?
Symptoms: Diarrhoea, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Flu like symptoms for roughly 3 days after receiving MMR vaccine at 13 months
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Nine
Diagnostic Lab Data: Went to Hospital ER on 7/9 in the evening. Was prescribed zofran on 7/9. Has been frequently drinking Pedialyte.
CDC Split Type:

Write-up: Received first moderna shot at 4:30pm on 7/8. Diarrhea and vomiting began at 7:30pm on 7/8. Continued diarrhea and vomiting on 7/9 and 7/10.

Administered by: Private       Purchased by: ?
Symptoms: Rash, Rash pruritic, 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: n/a
Current Illness: June 13, 2022 one day of isolated cough and congestion, rapid covid negative.
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: N/A.
CDC Split Type:

Write-up: Picked up from school 7/8 between 1730-1800. Noted to have hives most prominent on abdomen, right face, right arm, left arm. Rash was pruritic. Improved with diphenhydramine. Continued to wax and wane for 48 hours (time of report). Rash primarily located bilateral cheeks, abdomen, bilateral arms. No other symptoms. No known new exposure at school or detergents.

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

Write-up: Patient was given the wrong dose of vaccine- was given the Pfizer vaccine for 5-11 years of age

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: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None done to date
CDC Split Type:

Write-up: Patient was given the inappropriate dose of 1.25 ml of Moderna instead of 0.25ml. This was discovered after the patient had left but the provider called the mother to discuss the adverse event. Provider and Mom had thorough discussion and to this point the patient has not any reaction to the immunization dosage of 1.25 ml. Mom was advised to report any side effects the child has.

Administered by: Private       Purchased by: ?
Symptoms: Product administration error
SMQs:, Medication errors (narrow)

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

Write-up: Vaccine was reconstituted on the previous day and beyond the recommended 12 hour mark. Phone call made to Pfizer who supplied studies supporting vaccine continues to be stable up to 24 hours after reconstituting. Patient was vaccinated just shy of the 24 hour mark. Patient did not have any adverse effects, this was an administration error.

Administered by: Private       Purchased by: ?
Symptoms: Product administration error
SMQs:, Medication errors (narrow)

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

Write-up: Vaccine was reconstituted on the previous day and beyond the recommended 12 hour mark. Phone call made to Pfizer who supplied studies supporting vaccine continues to be stable up to 24 hours after reconstituting. Child was vaccinated just shy of the 24 hour mark. Child did not have any adverse effects, this was an administration error.

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Swelling, Tenderness
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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flonase
Current Illness: Diagnosis of campylobacter about a month earlier
Preexisting Conditions: Seasonal allergies
Allergies: Seasonal allergies (no specific testing)
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Large local area of erythema (5 x 3.5 cm) and swelling noted on 7/8 (8 days after initial injection) with mild tenderness but no fever or other symptoms. Initially worsened but started topical triamcinolone and has been gradually improving but not yet fully resolved.

Administered by: Pharmacy       Purchased by: ?
Symptoms: Peripheral swelling, Rash, Vaccination site erythema, Vaccination site mass
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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamins
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: No
CDC Split Type: vsafe

Write-up: On July 2, 2022 we noticed a small red bump at the vaccine site. On July 3, 2022 we noticed the red bump had gotten bigger and her arm was swollen and also had a rash, the swelling went down some but we took her to a walk-in clinic as it was a Sunday. The doctors at the clinic said it looked like what they were seeing as a delayed reaction to the Moderna vaccine. Give it until Wednesday to see if it would subside some or go away all together. By Wednesday it was completely gone.

Administered by: Private       Purchased by: ?
Symptoms: Gait disturbance, Pain in extremity
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (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: None
Current Illness: Upper respiratory infection a week before the vaccination (Non COVID-19 related)
Preexisting Conditions: None
Allergies: Tree Nuts
Diagnostic Lab Data: None
CDC Split Type: vsafe

Write-up: It started that Saturday the week after the vaccine. He woke up and said his leg started hurting and didn?t want to walk on it. When he did walk on it, he was limping. Later in the day, he started walking on it and was eventually just fine. Several days passed, and he reported the same symptoms another day when he woke up. There was leg pain, and he didn?t want to walk on it. The 2nd day was July 6, 2022 and continued on into the 7th. Since it persisted, we decided to make a doctor?s appointment which is later today. He?s still complaining of leg pain and there?s still a limp, but not as bad as it was. I didn?t notice any redness or swelling as well.

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Cough, Ear infection, Rhinorrhoea, SARS-CoV-2 test negative, SARS-CoV-2 test positive
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? 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: Two rapid test (positive) and two PCR test (negative).
CDC Split Type: vsafe

Write-up: After the vaccine, he was fine. He had a runny nose and a cough around July 2. On July 4 and July 6 he tested positive with the rapid test but tested negative on the PCR test on the same day. We had the PCR test done at the local ER. The ER doctor stated he had an ear infection and that our rapid test was wrong. They provided us with a prescription for amoxicillin. He is feeling better but he still has a runny nose.

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site induration, Injection site rash, Injection site swelling
SMQs:, 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: daily multi-vitamin gummy gummy fiber supplement
Current Illness: n/a
Preexisting Conditions: does get nose bleeds
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: A rash around the injection site with a hard bump underneath. He said it didn''t itch or hurt. Showed up a week after the injection. Looks to be getting better after day two of rash.

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

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

Write-up: 16 month old arrives to clinic with mother for vaccine update, however patient was administered 12 and older (gray cap) Pfizer ( COVID 19) by error. After realizing my administration error supervisor was notified immediately. Patient''s PCP, medical director, director of immunization department and patient''s mother where notified of error/incident. VEARS report was created, mother wrote an incident report, mother of patient was advised by PCP if patient develops any adverse reactions to please head to the emergency room. In case patient has any questions or concerns mother was advised to contact the clinic. Supervisor will be following up with patient.

Administered by: Private       Purchased by: ?
Symptoms: Excessive eye blinking
SMQs:, Ocular motility disorders (narrow)

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

Write-up: Patient''s parents reported noticing frequent eye blinking while watching tv the day after receiving her COVID19 vaccine and continuing intermittently. She has no eye irritation/ pain, does not seem to be aware she is doing this. no prior eye injury. She did not exhibit this behavior prior to her COVID19 vaccine. Patient was not evaluated for this concern- her dad reported it to me during her younger brother''s well visit on 7/5/22.

Administered by: Pharmacy       Purchased by: ?
Symptoms: Rash erythematous
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: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: WITHIN 5 MIN AFTER RECEIVING PEDIATRIC COVID-19 MODERNA VACCINE, PATIENT DEVELOPED SEVERAL RASH-LIKE RED SPOTS ON BOTH LOWER ARMS, BUT NOT AT THE INJECTION SITE. PATIENT SAID HIS BREATHING WAS FINE, AND NO ITCHINESS WHERE THE SPOTS WERE. MOM WAS ADVISED TO GIVE PATIENT BENADRYL WHEN GET HOME. I SPOKE TO MOM ON THE PHONE AROUND 4PM--SHE SAID HER DAD GAVE PATIENT 2.5ML BENADRYL AND PATIENT IS DOING FINE.

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
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: Urticaria noted on trunk less than 24 hours after vaccine resolved with use of Benadryl.

Administered by: Unknown       Purchased by: ?
Symptoms: Off label use
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: USMODERNATX, INC.MOD20226

Write-up: 6 month old was given a 0.25 ml (50 mcg) dose out of the red cap vial; This spontaneous case was reported by an other health care professional and describes the occurrence of OFF LABEL USE (6 month old was given a 0.25 ml (50 mcg) dose out of the red cap vial) in a 6-month-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 07-Jul-2022, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) .25 milliliter. On 07-Jul-2022, the patient experienced OFF LABEL USE (6 month old was given a 0.25 ml (50 mcg) dose out of the red cap vial). At the time of the report, OFF LABEL USE (6 month old was given a 0.25 ml (50 mcg) dose out of the red cap vial) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant information was reported. It was reported that no signs of adverse events were noted after administration. No treatment information was provided.

Administered by: Public       Purchased by: ?
Symptoms: Product use issue, Rash
SMQs:, Anaphylactic reaction (broad), 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? 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: USPFIZER INC202200936356

Write-up: rash around the shoulder area spread a little ways down towards belly and down the back; lot number FP7135; This is a spontaneous report received from a non-contactable reporter(s) (Consumer or other non HCP). A 2-year-old female patient received BNT162b2 (BNT162B2), on 06Jul2022 at 14:30 as dose 1, single (Lot number: FP7135) at the age of 2 years, in left leg for covid-19 immunisation. The patient''s relevant medical history was not reported. There were no concomitant medications. The following information was reported: PRODUCT USE ISSUE (non-serious) with onset 06Jul2022 at 13:30, outcome "unknown", described as "lot number FP7135"; RASH (non-serious) with onset 06Jul2022 at 13:45, outcome "recovering", described as "rash around the shoulder area spread a little ways down towards belly and down the back". The events "rash around the shoulder area spread a little ways down towards belly and down the back" required emergency room visit. Therapeutic measures were taken as a result of rash. Additional information: No other vaccine received in four weeks and no other medications in two weeks. Patient was not received covid prior vaccination and not tested covid post vaccination. It was reported that patient had a rash that wasn''t a severe reaction couple of mins after the shot. Was around the shoulder area and under the neck both front and back and rash spread a little ways down towards belly and down the back. AE resulted in Emergency room/department or urgent care. Doctor checked and gave Benadryl. No follow-up attempts are possible. No further information is expected.

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

Write-up: The Moderna 6mo-5Years was diluted with 2.2ml of 0.9% sodium chloride (normal saline, preservative -free diluent. Administered .2ml to left vastus lateralis. Parent notified 07/08/22 at 4:55pm of incident. No adverse reaction at that time. Educated parent to signs and symptoms of adverse reactions. A follow up call will ensue with the CDC recommendations for further vaccination information.

Administered by: Private       Purchased by: ?
Symptoms: Body temperature increased, Febrile convulsion, Feeling abnormal, Lethargy, Loss of consciousness, Seizure, Skin warm, Unresponsive to stimuli, Viral test negative
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), Dementia (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Virology panel was all negative.
CDC Split Type:

Write-up: After receiving vaccination, patient was out of it for approximately ~15 mins, after that period seemed lethargic but otherwise normal. Patient showed no other adverse reaction until time for his nap at 12:40p, when he felt warm to the touch but underarm temperature reading was 98.7. He woke up atypically early at 2:50p, but laid in crib seemingly playing quietly. At 3:56p, mother heard whimpering sound and went to check on patient who was convulsing and unconscious until EMS arrived at 4:03p, he was very hot but EMS was unable to get an accurate temperature reading. Convulsions stopped when paramedics arrived at approx. 4:03p and patient was unresponsive for an additional approx. 10 mins. Patient was placed under ice by EMS and had a temperature reading of 102.4 when he arrived Hospital in approx 20-30 mins later.

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

Write-up: The Moderna 6mo-5Years was diluted with 2.2ml of 0.9% sodium chloride (normal saline, preservative -free diluent. Administered .2ml to left vastus lateralis. Parent notified 07/08/22 at 4:49pm of incident. No adverse reaction at that time. Educated parent to signs and symptoms of adverse reactions. A follow up call will ensue with the CDC recommendations for further vaccination information.

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: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: N/a.
CDC Split Type:

Write-up: A 13month old was inadvertently given a higher than recommended dose of 3mcg for 6month to < 5years. The nurse did not dilute the vial at all and drew up 0.2mL of vaccine and administered it to patient. We realized the mistake within the 15min that the patient was here waiting. We reached out to VAERS, Pfizer Medical information, and ED on what we needed to next for patient. Dr. went into and told the mom that she received a higher than recommended dose. She discussed possible side effects and signs and symptoms to look out for. Gave her her personal number and advised to go directly to ED or call 911 if any symptoms develop.

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

Write-up: at around noon I was doing end of day covid vaccine count to discard unused doses, and I noticed my count for 5-11 doses was off I should have been wasting 6 but there was only 5, I should of also had 10 9 waste of the tender age Pfizer covid but had all 10, this patient''s mother had asked to receive Pfizer and Pfizer was ordered upon check in since I did the patients vitals. MA who administered. when I looked at the 5-11 covid admin sheet, this patients sticker was on. I then realized this patient has received a 5-11 covid Pfizer vax instead of the appropriately ordered Pfizer tender aged vax.I checked MAR to see if MA had scanned vax or manually entered. vaccine had been manually entered and therefore no hard stop would have been noticed by MA administering. Dose is counted and does not need to be repeated

Administered by: Private       Purchased by: ?
Symptoms: Herpes zoster, Varicella virus test positive
SMQs:, 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Varicella zoster culture positive.
CDC Split Type:

Write-up: Shingles/varicella Zoster infection to right leg.

Administered by: Public       Purchased by: ?
Symptoms: Diarrhoea, Fatigue, Laboratory test normal, Loss of personal independence in daily activities, SARS-CoV-2 test negative, Viral infection, Vomiting
SMQs:, Acute pancreatitis (broad), Dementia (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
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: negative.
CDC Split Type: vsafe

Write-up: Day of the vaccine she started to become fatigued. The next day at night she started to vomit. No noticeable pain or discomfort other than continuous vomiting. She went to school the next day however she did come home early. At day 3 post vaccine she started to have diarrhea as well. On Friday she started to feel better however continued to have diarrhea. On Saturday she was feeling back to normal. Went to a swimming class and in the late afternoon she began to vomit again and have diarrhea as well. We took her to ER and they did all the tests including COVID-19 tests and all were negative. They believe that it was due to a viral infection. The doctors did not believe it was due to the vaccine. She had IV fluids and was sent home. She has started feeling much better as of Saturday.

Administered by: Other       Purchased by: ?
Symptoms: Diet refusal, Lethargy, Malaise, Pyrexia, SARS-CoV-2 test negative, Streptococcus test negative
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: COVID-19 test - negative; Strep test - negative.
CDC Split Type: vsafe

Write-up: The night of the vaccine, she developed a fever and woke up. She has had a fever ever since the vaccine. She is lethargic and will not eat. I took her to the urgent care on 7/8/2022. She had a strep and COVID-19 test that were negative. Her highest fever was 104. I also took her to the ER yesterday. She is currently still sick.

Administered by: Private       Purchased by: ?
Symptoms: Lip swelling, 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)

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: Eczema and tree nut allergy
Allergies: Tree Nut Allergy
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dose 1 given at 11:01 and at about 11:16 AM father alerted us that his son was rubbing his face and scratching his neck. Face swollen with swelling of bilateral eyelids, upper lip swollen and visible hives on face and neck. Mouth was OK and no wheezes heard. Benadryl was offered at 11:25 and after about 10-15min the swelling of the eyelids and lip subsided and most of the facial hives gone and only a few remaining hives on neck. Observed until 11:45 and given instructions on when to return. Also, family has epipens at home for the preexisting tree nut allergy

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Injection site pain, Poor quality sleep, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: Covid more than 10 days before vaccination
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient developed a fever the evening of the 10th (the day he was vaccinated) and continued to have a fever for the entire following day. It was difficult to take his temperature but at one point, it was 101.5 even after he had take Tylenol. He also experienced pain at his injection site. He slept very poorly the evening of the 10th and was very tired the following day. By the morning of the 12th he appeared to be recovered, though he was still experiencing some tenderness at the injection site, as evidenced by him being afraid to put pants on because he didn''t want anyone to touch his thigh.

Administered by: Public       Purchased by: ?
Symptoms: Injection site extravasation, Vaccination error
SMQs:, Extravasation events (injections, infusions and implants) (narrow), 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: unknown
CDC Split Type:

Write-up: Patient was present in the clinic on 7/7/2022 for her 1st dose of Pfizer (6 months ? 4yrs formulation, lot number FT9142). RN, the vaccinator, went ahead to vaccinated on the right vastus lateralis, however when the needle (25G vanishing point) was 1/4 of the way piercing into the child skin; the child moved. The vaccinator attempted to follow and continue to insert the needle. Upon injecting, the dose was leaking at the injection site. Vaccinator and parent were able to witness that almost none of the dose enter the site. RN was able to assess the site for any scratching or bruising as well assessed for any bleeding. RN notified the Charge nurse, who was able to educate parent on the need for repeating dose on different site (left vastus lateralis) per our protocol, since less than half ? or rather none of the dose had entered the site. The parent was educated on watching the child for any bruising and that the child can be given children?s Tylenol for comfort. Parent expressed understanding and consented to re-administration of dose in opposite site. Client was able to successfully receive dose.

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

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

Write-up: RASH

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

Write-up: Pizer Pediatric vaccine 5-11 yr old formulation given to a 4 year old child in error.

Administered by: Public       Purchased by: ?
Symptoms: Immunisation reaction, Injection site erythema, Injection site pain, Injection site pruritus, Injection site rash, Injection site swelling
SMQs:, 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: Unilateral Hearing Loss / Profound Hearing Loss at her left ear. Normal Hearing at her right ear. No other health conditions.
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: *No serious adverse reactions - patient remained healthy. Exactly one week after receiving first COVID vaccine shot (Moderna) - patient (3yr) developed redness / slightly swollen marks at the injection site. The rash grew quickly to form one large area around the injection site. She commented early during onset that the area was itchy and tender, but it wasn''t painful. The large, slightly swollen, red rash remained for about 24 hours and then began to dissipate and slowly loose redness until completely going away. Based on comparison images online - it seems to match "covid arm" or "modern arm" similar to the reactions had by other adult modern vaccine recipients.

Administered by: Private       Purchased by: ?
Symptoms: Cough, Decreased appetite, 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? 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: Cough, treatment: prednisolone Fatigue Fever, treatment: acetaminophen Loss of appetite

Administered by: Other       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? 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: Error: Wrong Age for Vaccine Given-

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Redness/rash at injection site when he woke up on day 8 post shot.

Administered by: Public       Purchased by: ?
Symptoms: Cough, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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: Fever after getting one of her general pediatric shots. However it was only for a day and then symptoms would go away.
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: Over Counter Rapid Test: Negative
CDC Split Type: vsafe

Write-up: Friday, 2 days after the vaccine, daycare called us around 03:00PM and indicated that she had a fever over 101. We called the pediatrician and they instructed us to give her acetaminophen for symptoms. Since Friday, she has been experiencing waves of on and off fevers as well. She started to have a slight cough and congestion however no runny nose. Over the counter COVID-19 test showed negative result. Pediatrician examined and did not find anything in ears, nose, throat, or lungs. They did not see anything concerning however some respiratory symptoms.

Administered by: Public       Purchased by: ?
Symptoms: Eye infection, Eye swelling, Full blood count abnormal, Neutropenia, Neutrophil count decreased
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Angioedema (narrow), Haematopoietic leukopenia (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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: poly vi sol
Current Illness: none
Preexisting Conditions: Prematurity (33w 4d)
Allergies: none
Diagnostic Lab Data: CBC (7/3-7/7)
CDC Split Type:

Write-up: Eye infection, neutropenia. Eye swelling began 7/3, admitted 7/4, CBC showed low (<100) neutrophil. Antibiotics administered, discharged 7/7

Administered by: Public       Purchased by: ?
Symptoms: Fatigue, Pyrexia, SARS-CoV-2 test negative, 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), 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: Topical Cream for Eczema
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Peanuts; Cashews
Diagnostic Lab Data: COVID-19 Test: Negative
CDC Split Type: vsafe

Write-up: We started to notice that after lunch she vomited out her entire lunch while driving over to a friends house. After that, she seemed fine and played in the pool for a bit and everything was normal she did sleep over an hour and a half and seemed a little more tired than usual. After getting home later that evening we noticed that she began to run a small fever. We did not give her anything for the symptoms and she seemed to be fine and slept the entire night through. We then took her to the pediatrician the next day she still had a fever of 100, and at the visit they measured a temperature at 101. COVID-19 test was done and came back negative, they said she was well hydrated, everything else looked great. After getting home she took a two hour nap. Tylenol was given in the middle of the afternoon and fever went down and she seemed completely fine. As of the 12th, she has been completely fine and non symptomatic.

Administered by: Private       Purchased by: ?
Symptoms: Eye swelling, Hordeolum
SMQs:, Anaphylactic reaction (broad), Angioedema (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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: vitamins-multi, C, iron, probiotic, etc
Current Illness: fever of 101 and vomiting one week prior. incident resolved itself over a period of 7 hours.
Preexisting Conditions: Preemie twin born at 30 weeks. Gross motor skill delays and sensory integration issues.
Allergies: none knoen
Diagnostic Lab Data:
CDC Split Type:

Write-up: stye in left eye. then a week later, major swelling in right eye. both new occurrences with no history before vaccine

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No medications. No known dietary supplements or herbal remedies known at time at vaccination
Current Illness: No known illnesses at time of vaccination and up to one month prior
Preexisting Conditions: No known chronic or long standing health conditions
Allergies: No known allergies to food or medication
Diagnostic Lab Data: No medical tests or lab results related to event
CDC Split Type:

Write-up: Patient was administered Moderna vaccine on left deltoid intramuscularly 7/12/22. Patient received incorrect dosage of 0.5 ml instead of the 0.25 ml recommended at age range. Monitored at time of vaccination for 15 minutes and patient was tolerating well. Provider informed and communicated with patient father through phone of vaccine error 7/13/22. Doctor informed father of adverse effects and recommendations, father informed doctor patient was currently stable and had gone to play. . No known adverse effects at this time. Will continue to monitor.

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Ear infection, Hypersomnia, Infant irritability, Lethargy, Pyrexia, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Neonatal disorders (narrow), 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D drops
Current Illness: Ear Infection
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: COVID-19
CDC Split Type: vsafe

Write-up: 06/24/2022 Vaccination 07/02/2022 Patient had an ear infection, lethargic, extended naps which is unusual for him and spiked a fever of 103.2. I called Pedicatrian. We were out of town and to give him Motrin. It went down to 101 degrees. 07/03/2022 No fever. 07/06/2022 Patient was pretty fussy that afternoon. I asked the daycare to keep eye on him if he seemed more fussier. They called me and said they think something is wrong. I went to pick up Patient. 07/06/2022 Went to Pediatrician''s office for Ear Infection. Tested POSITIVE for COVID-19. I don''t know if symptoms were due to the ear infection or COVID-19. He''s doing better with Amoxicillin and Motrin. 07/11/2022 COVID-19 NEGATIVE

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest X-ray normal, Cough, Ear infection, Human rhinovirus test positive, Nasal congestion, Parvovirus B19 test positive, Parvovirus infection, Pyrexia, Rhinovirus infection, SARS-CoV-2 test negative, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Chest X-Ray-Normal COVID-19 Test Negative Rhino Virus- Positive Human Paraovirus- Positive
CDC Split Type: vsafe

Write-up: He started wheezing and having stuffy nose with a mild cough and kept on the entire week. On Sunday he had a fever all day long and got up to 103.7 and was not coming down and constantly coughing and wheezing bad. We called the on call Pediatric doctor and they suggested we go to the ER and his temperature there was 104.3. They gave him a chest X-ray and COVID-19 test and both were negative. They said he had a ear infection and offered antibiotics but we declined them. He tested positive for Rhino Virus, and Human Paraovirus. They advised to administer Ibuprofen since my wife refused the antibiotics. He has a appointment today with his regular pediatrician for follow up.

Administered by: Private       Purchased by: ?
Symptoms: Induration, Injection site rash, Rash erythematous, Rash papular
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Physical exam on 7/9/22
CDC Split Type:

Write-up: 8 days post-vaccination, pt developed a raised, bumpy erythematous rash at the site of the injection. ~1 in. Not itchy. Not tender. Within 24 hours, developed central clearing with underlying induration. ~1.5 inches. Not itchy. Not tender. Rash almost completely gone within 48 hours of symptom onset. NO OTHER ASSOCIATED SX.

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Child vaccinated with the Pfizer formulation for children ages 5-11 and he is younger than 5 years of age.

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain upper, Blood test normal, Borrelia test, Culture, Culture urine negative, Fatigue, Pyrexia, Urine output decreased
SMQs:, Acute renal failure (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Constipation
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Blood Culture; Urine Culture on 07/12/2022 Normal Tick/Lyme Disease Culture on 07/12/2022 Not Results Yet
CDC Split Type: vsafe

Write-up: On the evening of 07/07/2022 started running low grade fever from then until 07/11/2022. On 07/12/22 fever spiked up to 102.9 and the on the evening of 07/12/2022 she had stomach ache, fever up to 105.0, fatigued and low urine out put. She was taken to the ER at the Hospital and had normal blood and urine cultures. The Lyme/Tick cultures are still out and have not received the results yet. As of today she is still running a 99.0 fever.

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

Write-up: Pt was given wrong vaccine, pt given vaccine for 5-11 year olds

Administered by: Other       Purchased by: ?
Symptoms: Infant irritability, Poor feeding infant, Poor quality sleep, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Depression (excl suicide and self injury) (broad), Neonatal disorders (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: None
CDC Split Type:

Write-up: High fever started in the middle of the night, so around 1am on July 9. Fever went as high as 102 but was kept down with ibuprofen. Baby didn''t eat well that day and she had a very rough and restless night. Still had slight fever on July 10, and very fussy, gave alternating ibuprofen and Tylenol. Nurse practitioner saw baby to confirm no ear infection. We confirmed with the 2 families we saw the week prior that nobody else had been sick. Baby had no fever and was better following day July 11.

Administered by: Other       Purchased by: ?
Symptoms: Decreased appetite, Influenza A virus test negative, Influenza B virus test, Insomnia, Irritability, Pyrexia, Rash, Somnolence, Streptococcus test negative
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: No known allergies
Diagnostic Lab Data: 7/12/2022: flu swab A&B negative, strep test negative
CDC Split Type:

Write-up: 47 hours after receiving the shot Patient started getting a fever that lasted 48 hours in length. While he had the fever he was really sleepy during the day and then had a hard time sleeping at night. He had a poor appetite and was extremely irritable. After the fever went away he developed a rash that started on his buttocks and bilaterally on the back of his lower legs. Patient was taken to his primary care pediatrician but they did not think any treatment was necessary besides offering him whatever food or drink he would consume.

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Vaccination 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: NO AE - vaccine error. Patient received first dose of Moderna 6/22/22 at outside facility. Patient family did not make staff aware that they already received the first dose until after they were vaccinated again today and completed their 15min waiting period. Mom reports calling 211 and the Department of Health scheduling this appointment for the family.

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

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

Write-up: No AE - vaccine error. Patient received first vaccine 6/22/22 at outside clinic. Patient mother did not make staff aware that the patient already received their first dose until after patient received today''s dose. Patient mom reportedly called 211 to schedule their appointment and Department of Health staff scheduled the appointment for family.

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: N/A
Diagnostic Lab Data: None
CDC Split Type: IRIS patient ID: 769418

Write-up: Patient given adult Pfizer dose (grey cap) instead of pediatric Pfizer dose (maroon cap).

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: No adverse event occurred. Patient received incorrect vaccine. Patient should have received COVID-19, mRNA, LNP-S, PF, 3 mcg/0.2 mL dose, tris-sucrose (Pfizer PEDS 6m-4y (maroon). And patient received COVID-19, mRNA, LNP-S, PF, 10 mcg/0.2 mL dose, tris-sucrose (Pfizer PEDS 5y-11y (orange).

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Moderate diarrhea lasted 2 days

Administered by: Public       Purchased by: ?
Symptoms: Diarrhoea, Fatigue, Pyrexia, SARS-CoV-2 test negative
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Drive through COVID test (covid not detected) on 7/10/2022
CDC Split Type:

Write-up: Diarrhea on 7/6 - 9:11am and 3:18pm Diarrhea on 7/8 - 4:07pm Fever 7/10 8am - 7/12 up to 102 Fatigue 7/10 - 7/12

Administered by: Pharmacy       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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin with fluoride
Current Illness: Flu in May
Preexisting Conditions: Beta thalassemia minor Eczema
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Severe redness, swelling and hotness at injection site

Administered by: Private       Purchased by: ?
Symptoms: Injection site erythema
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: