Found 4,276 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: 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: PT HAD NO REACTION TO VACCINE . PT WAS MONITORED X15 MINS WITH NO COMPLAINS ADRVISED MOTHER ABOUT ER PRECAUTIONS

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dose administered, 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 3 year old Pt was given pediatric dose of Pfizer Covid-19 injection of 0.2mL/10mcg instead of 0.2mL/3mcg. Follow up completed with Pt''s parents 3 days later who state that the Pt has no side effects besides some localized swelling at the injection site. Pt is well and acting normally.

Administered by: Public       Purchased by: ?
Symptoms: Syringe issue
SMQs:, Medication errors (broad)

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

Write-up: Nurse gave vaccine and Mom said she saw some squirt out. Nurse did not see it squirt out and when Mom was asked how much squirted out, she said it was "just a little bit!" When given the option to re-vaccinate, she did not want him vaccinated again.

Administered by: Unknown       Purchased by: ?
Symptoms: Scratch, Syringe issue
SMQs:, Accidents and injuries (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Needle inserted into patients L thigh, but vaccine was not administered. Patient slapped the syringe and the needle bent. RN was able to remove entire needle. Small scratch noted on L thigh.

Administered by: Public       Purchased by: ?
Symptoms: Needle 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccinator injected patient with empty needle, rather than syringe filled with vaccine. She then corrected her mistake and the dose was administered correctly. Mother assured the first needle was not contaminated.

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Rash, Skin discolouration, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: MMR-V at 1 year old; moderate side effects with measles rash and fever 10 days post-vaccine. She received the second vaccine at
Other Medications: None in the 36 hours prior to vaccination,
Current Illness: Food allergy reaction 3-4 days prior. She had hives only, but they recurred through Sunday 6/19/22. Treated with Benadryl on 6/17/22 and 6/19/22. It was a food (mustard) she had previously tested negative for and deemed the allergy outgrown. Previously she had a couple of colds, and tested negative for COVID regularly throughout month prior.
Preexisting Conditions: N/a
Allergies: Mustard, horses, dust
Diagnostic Lab Data:
CDC Split Type:

Write-up: Blueish and red discoloration in legs that looked like the start of a severe hive break out or other rash. Rash was noticed about 5 minutes after injection. Pharmacist administered 5ml of liquid Benadryl about 5-7 minutes post vaccine injection. The symptoms dissipated about 25-30 minutes later.

Administered by: Other       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: montelukast 4mg, cetirizine 1mg/ml 2.5 ml, albuterol 2.5mg/3ml
Current Illness:
Preexisting Conditions: Reactive airway disease, allergic rhinitis, eczema, speeh delay, thrombocytosis, leukocytosis, acid reflux, dry skin,
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is age 3 years 11 months. Patient was given covid vaccine pfizer intended for age group 5-11 years of age. No adverse outcomes known.

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect dose administered, No adverse event, Product preparation 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: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: The nurse incorrectly reconstituted the Pfizer COVID vaccine (59267-0078-04) using 0.22 mL of diluent, instead of the correct 2.2 mL. The correct volume of 0.2 mL was administered to the child, but due to incorrect reconstitution, the dose (mcg) was higher than desired. Only 1 dose was administered from this vial. The error was identified when the nurse was drawing up the remaining doses to waste and only got 2.5 doses, instead of the expected 9 more to equal 10 total. Thus we estimate the dose administered was appoximately 3x the desired, or close to 10 mcg - the dose appropriate for 5-11 year olds. The patient''s mother was notified and counseled appropriately. No adverse reactions noted.

Administered by: Public       Purchased by: ?
Symptoms: Intentional removal of drug delivery system by patient
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: Nurse stuck needle in child''s arm to vaccinate, but child pulled away before vaccine was administer. Dose was wasted and child was vaccinated in the opposite arm.

Administered by: Public       Purchased by: ?
Symptoms: Needle issue
SMQs:, Medication errors (broad)

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

Write-up: Nurse stuck needle in child''s arm to vaccinate, but child pulled arm away before vaccine was administered. Nurse wasted that dose and administered the vaccine in the opposite arm.

Administered by: Other       Purchased by: ?
Symptoms: 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: None
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Vaccinator inserted needle into pt''s arm. Mother did not have a good hold and pt moved. Needle came out before vaccinator was able to inject. Pt was then vaccinated with full dose.

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Rash, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (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? 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: Cefdinir
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: mom noted bumps and redness over left eye and left ear. Then it looked like it was spreading to eye brow, ear ,all they way up, then left cheek, redness was on both cheeks, pale area was in center of cheek redness. Overall, the exanthem ultimately resembled that of 5th disease, with cheek redness and a reticular faint exanthem on the extremities. There was quick resolution of the rash after the child was moved to a cool indoor environment.

Administered by: Public       Purchased by: ?
Symptoms: Rhinorrhoea
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: Nystatin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: No symptoms of illness day of vaccination but the next day had a very runny nose.

Administered by: Other       Purchased by: ?
Symptoms: Circumstance or information capable of leading to medication error, Underdose
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: EUA - young moderna dose 1. Patient moved away during administration and only received a partial dose (majority of solution was not injected). Parent informed and clinical team. Patient was re-vaccinated per guidelines. no issues/reaction noted to scriber during time of this report.

Administered by: Public       Purchased by: ?
Symptoms: Drug screen negative, Hallucination, visual, Psychotic disorder, Specific gravity urine normal, pH urine normal
SMQs:, Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hostility/aggression (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: Suspected Sensory-Processing Disorder
Allergies: None
Diagnostic Lab Data: Urinalysis: specific gravity 1.005, pH 7.0, dip negative Urine toxicology screen: negative (screen includes barbiturates, benzodiazepines, cannabinoids, cocaine, methadone, opiates, oxycodone, phyencyclidine, and fentanyl)
CDC Split Type:

Write-up: Patient developed sudden onset hallucinations (visual, possibly auditory) and psychosis beginning 6 hours after vaccination and lasting for 7 hours, then fell asleep. Reawakened with more hallucinations/psychosis 16 hours after vaccination (6 am today) lasting for another 1.5 hours. Transported to Pediatric ED where psychosis/hallucinations resolved. Examination normal. Remained at baseline (normal) upon discharge from ED.

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: NO ADVERSE EFFECT REPORTED . PATIENT IS 2 YEARS OLD .. LOCAL LAW/PROTOCOL ALLOWS PHARMACIST TO VACCINATE KIDS AGE 3 AND UP

Administered by: Private       Purchased by: ?
Symptoms: 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Febrile cold 3 wk earlier.
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Vomiting about 8 hours after vaccine given up until 12 hours after. Unclear whether vaccine related or just standard food poisoning.

Administered by: Other       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 reported by parent.
Current Illness: None reported by parent.
Preexisting Conditions: None reported by parent.
Allergies: None reported by parent.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient moved during vaccination attempt and over half of COVID 19 vaccine was not injected intramuscularly. Patient returned on 6/23/22 to another mobile vaccine clinic to receive full dose appropriate for her age.

Administered by: Public       Purchased by: ?
Symptoms: 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever.

Administered by: Senior Living       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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hirschsprung?s Disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Diarrhea Vomiting

Administered by: Public       Purchased by: ?
Symptoms: Erythema, 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: Multi vitamin for Kids
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type: vsafe

Write-up: About an hour after her vaccination, she began to have welts rise in random spots around her body, this included arms, back and legs. Some were red and some that emerged began to turn white. The welt on the thigh was as big as mother''s hand and they look closely like mosquito bites. Mother did try to get in touch with pediatrician however they were not able to get in touch with her as of yet. Mother did take participant to Pediatric emergency room where they treated her with benadryl for her symptoms. They were starting to go down prior to arriving to the ER, and with the Benadryl and the welts were almost completely gone by the time they left the ER around 05:45 PM same day. Slight showing of welts on patient''s arm was visible in morning today, however no Benadryl is needed as no discomfort is shown and patient seems to be doing fine and acting normal.

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

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

Write-up: Undiluted covax vaccine administered to client. At this time no reports of needed treatments or adverse reactions.

Administered by: Private       Purchased by: ?
Symptoms: Pharyngeal swelling, Swelling face, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), 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? 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: swollen face, swollen throat, wheezing. Was treated at ER with epipen and oral steroids.

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

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

Write-up: Pt was given Pfizer dose that did not have enough diluent. Only diluted with 1mL of saline instead of 2.2 mL of saline.

Administered by: Private       Purchased by: ?
Symptoms: Rash, 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: No allergies.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: After 10 minutes after receiving vaccine, patient developed red rash on forehead and temples. Rash resolved after 15-20 minutes.

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

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

Write-up: Within first 15 minutes of observation patient was noted to have new rash by parent. No respiratory distress noted and no angioedema noted. Patient was taken to pediatric clinic within medical center for further MD evaluation per pediatrician request.

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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None known.
Preexisting Conditions: None.
Allergies: None
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Diarrhea

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20220621; Test Name: Body temperature; Result Unstructured Data: 100.6; Test Date: 20220622; Test Name: Body temperature; Result Unstructured Data: 104.2
CDC Split Type: USMODERNATX, INC.MOD20225

Write-up: At 8.30pm had a fever of 100.6 and at 8am this morning of 104.2; This spontaneous case was reported by a consumer and describes the occurrence of PYREXIA (At 8.30pm had a fever of 100.6 and at 8am this morning of 104.2) in a 12-month-old patient of an unknown gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 prophylaxis. No Medical History information was reported. On 21-Jun-2022 at 3:00 PM, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 21-Jun-2022 at 8:30 PM, the patient experienced PYREXIA (At 8.30pm had a fever of 100.6 and at 8am this morning of 104.2). The patient was treated with IBUPROFEN at an unspecified dose and frequency and ACETAMINOPHEN at an unspecified dose and frequency. At the time of the report, PYREXIA (At 8.30pm had a fever of 100.6 and at 8am this morning of 104.2) had not resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 21-Jun-2022, Body temperature: 100.6 100.6. On 22-Jun-2022, Body temperature: 104.2 104.2. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medication was provided It was reported that patient had experienced at 8.30 pm had a fever of 100.6 on 21 Jun 2022 and at 8 am 104.2 on 22 Jun 2022. The patient had not received any medical care yet.

Administered by: Unknown       Purchased by: ?
Symptoms: Hyperhidrosis, Pyrexia
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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Ear infection (Fighting an ear infection and on antibiotics)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20225

Write-up: He had a mild fever/sweat; He had a mild fever/sweat; This spontaneous case was reported by a patient family member or friend and describes the occurrence of HYPERHIDROSIS (He had a mild fever/sweat) and PYREXIA (He had a mild fever/sweat) in a 3-year-old male patient who received mRNA-1273 (Spikevax) for COVID-19 prophylaxis. Concurrent medical conditions included Ear infection (Fighting an ear infection and on antibiotics). On 21-Jun-2022, the patient received first dose of mRNA-1273 (Spikevax) (unknown route) 1 dosage form. On 23-Jun-2022, the patient experienced HYPERHIDROSIS (He had a mild fever/sweat) and PYREXIA (He had a mild fever/sweat). On 23-Jun-2022, HYPERHIDROSIS (He had a mild fever/sweat) and PYREXIA (He had a mild fever/sweat) had resolved. The action taken with mRNA-1273 (Spikevax) (Unknown) was unknown. Concomitant medications included unspecified antibiotics. It was reported that, in the middle of night of 22-Jun-2022 (early hours of 23-Jun-2022), patient had mild fever and sweat. The fever and sweat did not last that long and patient woke up fine. Patient was not sure if it was related to the vaccine or not. Patient was simultaneously fighting an ear infection and on antibiotic, though there was no fever associated with the ear infection over the prior week. No treatment medications were reported.

Administered by: Private       Purchased by: ?
Symptoms: Anxiety, No adverse event, Wrong technique in product usage process
SMQs:, 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: No known allergies
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: I am reporting this as an error in administration of the vaccine. The patient did not experience any symptomatic adverse reaction. My child received the vaccine and then we left the office. About 15 minutes later I received a phone call from the doctor''s office asking that I come back because there had been a mistake in dosage. The nurse told me that she had accidentally given a lower dose than prescribed and that my child needed a second dose. My child has not experienced any adverse symptoms as a result of this error but it was very inconvenient and caused my child unnecessary anxiety by having to go back for a second shot.

Administered by: Private       Purchased by: ?
Symptoms: Anxiety, No adverse event, Product administration error, Underdose
SMQs:, 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: No known allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I am reporting this as an error in administration of the vaccine. My child did not experience any adverse symptoms due to this error. My child received the vaccine and then we left the office. About 15 minutes later I received a phone call from the nurse asking use to come back because there was an accidental error in the dosage that was administered. The nurse told me that my child had accidentally received a lower dose than prescribed and we had to come back to get a 2nd dose. Although my child did not experience any adverse symptoms due to this error, it was inconvenient and my child experienced unnecessary anxiety by having to go back for a 2nd shot.

Administered by: Unknown       Purchased by: ?
Symptoms: Product dose omission issue
SMQs:, Medication errors (broad)

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

Write-up: injected left arm Pt moved no vaccine administered .wasted the vaccine administered the new vaccine on the right arm.

Administered by: Pharmacy       Purchased by: ?
Symptoms: Sensory disturbance
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (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 medication taken
Current Illness: No
Preexisting Conditions: Good health conditions
Allergies: No allergies to medication or food
Diagnostic Lab Data: Na
CDC Split Type:

Write-up: Rush in the body, arms, chest and neck

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: Unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: 4 year old was given vaccine for 5-11 year old

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

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

Write-up: 4 year old was given vaccine for 5-11 year old.

Administered by: Other       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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NKA
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: A 2-YEAR-OLD WAS GIVEN AN ADULT DOSE OF PFIZER. THERE WAS NO ADVERSE REACTION NOTED

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: eczema
Allergies: None
Diagnostic Lab Data: None, but referred to allergist for dose two.
CDC Split Type:

Write-up: Diffuse rash. Started on back of neck, spread down arms and legs. Bright red, papular, non-blanching. Not itching, no trouble breathing, no changes at site of vaccine, no complaints. Given Benadryl, but nothing changed.

Administered by: Private       Purchased by: ?
Symptoms: Decreased appetite, 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Cold
Preexisting Conditions: None
Allergies: Augmentin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Low grade fever 101 F, vomiting, decreased appetite.

Administered by: Other       Purchased by: ?
Symptoms: 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Error: Incorrect Reconstitution-

Administered by: Private       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: None
Current Illness: Rhinovirus/enterovirus 1 week prior
Preexisting Conditions: Horner syndrome
Allergies: History of egg allergy but outgrown
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Acute urticaria

Administered by: Other       Purchased by: ?
Symptoms: Erythema marginatum
SMQs:

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

Write-up: Asymptomatic erythema marginatum rash 2 days after first dose.

Administered by: Pharmacy       Purchased by: ?
Symptoms: Decreased appetite, Fatigue, Headache, Irritability, Malaise, Rhinorrhoea, Sneezing
SMQs:, Anaphylactic reaction (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Sneezing, Runny nose, headache, feeling unwell, irritability, decreased appetite, tiredness.

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pyrexia, Rash, Rash erythematous, Rash macular, 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? 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: Whole body rash, started about 7 hours after injection. Looked like mosquito bites on legs. By 24 hours after injection, rash had progressed to 1/2 to 3/4 circles with red margin. Many of the circles had merged into larger splotches. Covered abdomen and most of the legs completely. 100F fever starting about 30 hours after injection. Rash is slightly itchy, slightly painful when touched. Treated itchiness with benedryl. Treated fever with tylenol.

Administered by: Pharmacy       Purchased by: ?
Symptoms: Circumstance or information capable of leading to medication error, Injury associated with device
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: At the time I was going to inject the vaccine into the patient''s arm, he moved and subsequently got punctured by the needle. The vaccine had to be re-administered shortly thereafter.

Administered by: Private       Purchased by: ?
Symptoms: Joint range of motion decreased, Laboratory test, Screaming, X-ray normal
SMQs:, Hostility/aggression (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Melatonin .25mg
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: X-ray was completed on 6/25/22 at the Emergency Room - no injury was shown.
CDC Split Type:

Write-up: My son (2 years, 8 months) received the Pfizer COVID 19 injection in his left arm on Friday morning at 9am. His behavior was normal after the injection, he did not complain of any pain and was playing and running as normal. He went to bed at 730 without any issues and still no side effects from the injection. On Saturday 6/25/2022 at around 6:45 he woke up screaming because he could not move his head. If he moved, he would scream in agony. His head maintained a position to the right without inducing pain. Motrin and Tylenol were given with no impact. Urgent Care was called and instructed to give Benedryl 5mg and wait 1 hour to see if symptoms improved. At 45 minutes after the benedryl was given, he was still screaming at any movement. He remained laying with his head to the right without any issue but otherwise could not move his neck. Other extremities were fine, no rashes. He was not warm to the touch but temperature was not taken. Since he was still in pain and unable to move, he was taken to the Emergency Room in. They completed additional tests, including temperature to which no fever was recorded. X-rays which showed no injury. However no improvement was being made. He was given additional Ibuprofen. Heating pads were put on his upper neck. Slow movements were made by family and nurses and after 5 hours he was able to sit upright leaning back on the bed. He eventually was able to then stand and walk around. Instructions were to continue Motrin at regular dosing times 24/7 at home. The following day, Sunday 6/26/2022, there are no signs of any pain. He is not complaining of any pain and is active and back to normal self.

Administered by: Public       Purchased by: ?
Symptoms: Rash, Rash erythematous, Rash papular
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: Mild URI $g14 days prior to vaccination.
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Rash on trunk and extremities. Small, red, raised bumps.

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Elderberry syrup
Current Illness: None
Preexisting Conditions: None
Allergies: Environmental (pollen)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Began with small rash under armpit on left side. First noticed around 8am on Sunday June 26. Rash is now also on left cheek and left back. Looks like hives

Administered by: Private       Purchased by: ?
Symptoms: Dry skin, Pallor, Rash, Rash papular
SMQs:, Anaphylactic reaction (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaminophen and ibuprofen the night before
Current Illness: did feel a little warm yesterday, t-max 99.8 (tympanic) also with some atypical stools lately, but not true diarrhea
Preexisting Conditions: growth concerns, failure to thrive (initial appointments with GI and allergy groups pending)
Allergies: known anaphylaxis to direct dairy products (tolerates dairy in baked goods) has never actually had any direct egg exposure/ingestion, so allergy to egg is possible but unknown (does tolerate egg in baked products)
Diagnostic Lab Data:
CDC Split Type:

Write-up: apx 30-60 min after vaccine, developed fine, dry, rough, blanchable, papular rash upon trunk, face, and extermities does not seem pruritic no other symptoms involved given diphenhydramine in clinic plan: scheduled antihistamine now, follow-up with allergist as planned (already scheduled for time before vax #2 would be due), given epi-pen and go to ER for difficulty breathing/swallowing, facial/lip swelling, vomiting (already has epipen)

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Gait deviation, 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi vitamin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Started feeling dizzy at 10:30pm on 6/25/22 (woke up feeling dizzy) and unable to walk straight. Went back to sleep and starting throwing up in bed at 12:30am on 6/26/22.

Administered by: Pharmacy       Purchased by: ?
Symptoms: Circumstance or information capable of leading to medication error, No adverse event, 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? 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 is 3 years old but was given Pfizer Covid vaccine for the age (5-11y), this mistake was done because of the information that was filled online in the consent form by his parents . the consent form had the age 5 and the type of vaccination was Pfizer (5-11y) the vaccine went through the insurance without any problems even with the patient''s name and DOB when the mom was asked in the room to confirm the child''s date of birth she mentioned year and based on that pt was given the vaccine for 5YO not for 3YO His mother checked with the DR , DR said" it is fine and he will be okay " I called the mother next day 06/25/2022 and asked about patient, she said he is perfectly fine and playing with no problems at all

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Patient has non-classic congenital adrenal hyperplasia
Allergies: None
Diagnostic Lab Data: none
CDC Split Type:

Write-up: About 7 hours after receiving the vaccination, patient vomited 6 times over the course of 3 hours. She had no fever and no other symptoms.

Administered by: Public       Purchased by: ?
Symptoms: Decreased appetite, Incontinence, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever for 36+ hours. Reached high of 104.4 the second night after vaccination. No appetite. Nighttime incontinence during the high fever night. Fever is controlled by alternating acetaminophen and ibuprofen, but it hasn?t been down lower than 100 for more than an hour at a time.

Administered by: Private       Purchased by: ?
Symptoms: 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? 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: hives and itchiness hands and torso, no respiratory distress. Treated with benadryl and improved. Had a hive on hand and torso following day

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

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

Write-up: Error: Wrong Age for Vaccine Given-

Administered by: Unknown       Purchased by: ?
Symptoms: Needle issue, Wrong technique in product usage process
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: USMODERNATX, INC.MOD20225

Write-up: Needle bent while receiving the Moderna Covid 19 vaccine; pharmacist bent the needle in his left tight; This spontaneous case was reported by a patient family member or friend and describes the occurrence of NEEDLE ISSUE (Needle bent while receiving the Moderna Covid 19 vaccine) and WRONG TECHNIQUE IN PRODUCT USAGE PROCESS (pharmacist bent the needle in his left tight) in a 3-year-old male patient who received mRNA-1273 (Spikevax) (batch no. A51416B) for COVID-19 vaccination. No Medical History information was reported. On 22-Jun-2022, the patient received first dose of mRNA-1273 (Spikevax) (unknown route) 1 dosage form. On 22-Jun-2022, the patient experienced NEEDLE ISSUE (Needle bent while receiving the Moderna Covid 19 vaccine) and WRONG TECHNIQUE IN PRODUCT USAGE PROCESS (pharmacist bent the needle in his left tight). At the time of the report, NEEDLE ISSUE (Needle bent while receiving the Moderna Covid 19 vaccine) and WRONG TECHNIQUE IN PRODUCT USAGE PROCESS (pharmacist bent the needle in his left tight) outcome was unknown. No allergies was not reported by the reporter. Concomitant medication details were not reported by the reporter. when the patient received vaccine, the pharmacist bent the needle in his left tight. The mother had now doubts and was worried because she was not sure if patient received the correct vaccine and dosage for his age group. The mother asked the pharmacist if she had administered the 30 mg of the vaccine and the Pharmacist said yes, But the mother was not sure if pharmacist was really paying attention. She was panicked because she did not know if the dosage of patient was received correct. The pharmacist said that the patient was able to receive the full dose, even though the needle bent. Treatment details was not reported by the reporter.

Administered by: Pharmacy       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: Amoxicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Admin Error Occurred

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? 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: Administration error occurred.

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (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? 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: The next day at about 12pm patient complained of abdominal pain, at about 5pm he started vomiting and had a fever that persisted until the following day, up to 103. Could not keep anything down and had to be brought to urgent care, got zofran there.

Administered by: Private       Purchased by: ?
Symptoms: Pyrexia, Rash papular
SMQs:, 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: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: fever to 101 and diffuse papulovesicular rash

Administered by: Private       Purchased by: ?
Symptoms: Crying, Screaming
SMQs:, Hostility/aggression (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 6/25/2022 11:10am vaccine 6/27/2022 12:25am woke up from night sleep crying, escalated to inconsolable crying/screaming as she has never cried/screamed before. Checked temperature, normal. Gave infant Tylenol. Eventually fell asleep after crying/screaming in mother''s arms for 20+ minutes, refused breast (which is normal comfort).

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Headache, 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: Through blood test: cashews and pistachio Formerly: egg (when under 2)
Diagnostic Lab Data: N/A - We haven''t had any medical tests or laboratory results done yet.
CDC Split Type:

Write-up: Child complained of itchiness, especially around the neck. Thurs-Sun -- just applied lotion (Aveeno baby lotion) after showering in the evening. On Monday morning (6/27) around 8AM, child complained of extreme itchiness and asked for me to take pictures. Her neck/check area was very red as well as the back of the neck up to the hairline. I applied 2.5% hydrocortisone ointment after this time. Child also complained of a headache on Sunday afternoon (probably around 2PM through 5PM or so).

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

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

Write-up: She got her vaccine at 9am; at about 2:30pm, she went outside to play and I noticed she had hives on her chest, sides, and back. I took her to urgent care worried whether it was a reaction to the vaccine. The doctor couldn''t completely diagnose whether it was caused from the vaccine, but informed me to give her Benadryl to see if it''ll subside her reaction. He also told me to follow-up with an immunologist before receiving second dose to confirm whether it was vaccine-related. on the way home, bought Benadryl and gave it to her right before bed at 6:15pm. When she woke up the next morning, the hives went away at night, and she was fine.

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Feverish from various childhood vaccines, however they did not last long.
Other Medications: Vitamin D; probiotic supplement; omega 3
Current Illness: COVID-19 05/23/2022
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type: vsafe

Write-up: Pediatrician messaged because he wouldn''t stop vomiting after vaccine after about 5 hours later. He did not have any symptoms immediately after the vaccination was administered. Our pediatrician asked if he was experiencing other symptoms that seemed like an allergic reaction, such as hives, swelling, pale color which he did not. Given recommendations on helping control the vomiting and hydration, and to keep them updated on his symptoms. He is now feeling much better from yesterday, and has now had no episodes of vomiting.

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluoride
Current Illness: none
Preexisting Conditions: None
Allergies: Allergies to Garbanzo Beans, Peaanut, Seasame, Almond, Nut, Hazelnut, Sunflower.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient developed hive like rash on extremites and puffiness/redness of face 27 minutes after injection.

Administered by: Other       Purchased by: ?
Symptoms: Dyspnoea, Erythema, Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: He started with a fever on June 25, 2022. On June 26th he woke up with a fever, and he had red hives on him. They got worse through out the day, and they spread all over his body. We talked with a doctor who recommended giving him BENADRYL. We went to the ER later that day because he was having trouble breathing. He was given BENADRYL and a prednisolone steroid. He is still on those medications and will be for a couple of days.

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Crying, Insomnia, Irritability, Pyrexia, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Miralax
Current Illness: none
Preexisting Conditions: none
Allergies: She used to have an egg allergy, but she out grew it.
Diagnostic Lab Data: Covid Test- positive (6/25/2022)
CDC Split Type: vsafe

Write-up: June 24, 2022 she woke up very weepy and cranky, and that progressed throughout the day. She is usually very cheerful. She also had trouble sleeping. The next day on she Saturday morning woke up with a fever. On June 26th her fever broke around 3:00PM.

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

Write-up: Systemic: Vomiting-Mild, Additional Details: pt vomited once

Administered by: Public       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: N/A
Current Illness: None
Preexisting Conditions: Unknown
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient was receiving the Moderna vaccine and jerked his arm. Medication was not administered and was wasted. Patient was not harmed or injured. Parent authorized re-administration. Fresh vaccine was drawn and administered without complications. Post vaccination, patient was monitored for 30 minutes without any adverse events/ complications.

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

Write-up: The 5-11 vial (10mcg/mL) was diluted 2ith 2.2 mL sodium chloride and given to 3 year old patient. Guardian of patient was notified. Patient is not experiencing side effects at this time.

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? 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: Vial initially punctured on 6/22/22 at 5:05pm. Dose for this patient was drawn up at 8:15am on 6/23/22, more than 12 hours after the initial puncture date. Vaccine was administered. Error was identified, patient was notified. No adverse health effects.

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

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