|
VAERS ID: |
921566 (history) |
Form: |
Version 2.0 |
Age: |
8.0 |
Sex: |
Male |
Location: |
California |
Vaccinated: |
2021-01-04 |
Onset: |
2021-01-04 |
Days after vaccination: |
0 |
Submitted: |
0000-00-00 |
Entered: |
2021-01-05 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
025 J20-2A / 1 |
LA / IM |
Administered by: Private Purchased by: ? Symptoms: Unevaluable event SMQs: Life Threatening? No Birth Defect? No Died? No Permanent Disability? No Recovered? Yes Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: Other Medications: Adderall XR 5 mg oral capsule, extended release, 5 mg, 1 Cap, ORAL, QMorning Current Illness: ADHD Preexisting Conditions: ADHD Allergies: None Known Diagnostic Lab Data: CDC Split Type: Write-up: Covid Vaccine given to person less that 18 years old. No complications at this time |
|
VAERS ID: |
954161 (history) |
Form: |
Version 2.0 |
Age: |
8.0 |
Sex: |
Female |
Location: |
Unknown |
Vaccinated: |
2021-01-06 |
Onset: |
2021-01-06 |
Days after vaccination: |
0 |
Submitted: |
0000-00-00 |
Entered: |
2021-01-09 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
039K29A / UNK |
LA / IM |
Administered by: Other Purchased by: ? Symptoms: Palpitations, Respiratory depression, Tachycardia SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Respiratory failure (narrow), Dehydration (broad) Life Threatening? No Birth Defect? No Died? No Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? Yes Hospitalized? No Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: Write-up: RespDepression, Palpitations & Tachycardia Narrative: |
|
VAERS ID: |
956768 (history) |
Form: |
Version 2.0 |
Age: |
7.0 |
Sex: |
Male |
Location: |
Arizona |
Vaccinated: |
2021-01-12 |
Onset: |
2021-01-12 |
Days after vaccination: |
0 |
Submitted: |
0000-00-00 |
Entered: |
2021-01-19 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL 3249 / 1 |
UN / IM |
Administered by: Public Purchased by: ? Symptoms: Pain in extremity, Product administered to patient of inappropriate age, Pyrexia SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad) Life Threatening? No Birth Defect? No Died? No Permanent Disability? No Recovered? Yes Office Visit? Yes ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: Other Medications: On January 12, 2021 a family went to a vaccine POD run by the Arizona Department of Health Services to receive COVID-19 vaccines; time of vaccination and time of adverse reaction is unknown. They were told that everyone in the car could g Current Illness: No illness at the time of vaccination. Patient had recovered from COVID-19 in December. Preexisting Conditions: There were no chronic or long standing health conditions reported. Allergies: No allergies were reported. Diagnostic Lab Data: No medical tests or laboratory tests were reported as having been administered. CDC Split Type: Write-up: Pfizer COVID-19 Vaccine is authorized for use in individuals less than 16 years of age. The 7 year old had a sore arm along with fever and fatigue starting about 24 hours after the vaccine that lasted for 2 days. |
|
VAERS ID: |
960525 (history) |
Form: |
Version 2.0 |
Age: |
11.0 |
Sex: |
Male |
Location: |
California |
Vaccinated: |
2021-01-19 |
Onset: |
2021-01-19 |
Days after vaccination: |
0 |
Submitted: |
0000-00-00 |
Entered: |
2021-01-21 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
042L20A / 1 |
- / IM |
Administered by: Private Purchased by: ? Symptoms: Product administered to patient of inappropriate age SMQs:, Medication errors (narrow) Life Threatening? No Birth Defect? No Died? No Permanent Disability? No Recovered? 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: Family of 4 (two parents and two minors) made 4 appointments for vaccine. Parents presented a letter re being caregivers for developmentally disabled kids as verification for registering all 4 for vaccine and were allowed to enter. Vaccinator vaccinated parents and this child when a supervisor saw the minor and stopped the process. However this minor received Moderna vaccine. Parents were upset that the 2nd child was not vaccinated and upset at process that "they were told it was ok". MD on site was informed and confirmed that no one under the age of 18 is permitted vaccine and informed family that it was not allowed. They protested and wanted to talk to "someone who approved the letter". It was confirmed that letter supported parental vaccination. Nonetheless, BOTH children had been registered and one vaccinated. Needs reporting to VAERS and I recommend risk management. Lot # 042L20A All registration personnel were reminded that no one under age of 18 is to be registered for vaccine, and nurse was educated. Vaccination education will include age limitations as well going forward. |
|
VAERS ID: |
960816 (history) |
Form: |
Version 2.0 |
Age: |
8.0 |
Sex: |
Unknown |
Location: |
California |
Vaccinated: |
2021-01-04 |
Onset: |
2021-01-04 |
Days after vaccination: |
0 |
Submitted: |
0000-00-00 |
Entered: |
2021-01-21 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
- / 1 |
- / OT |
Administered by: Unknown Purchased by: ? Symptoms: Poor quality product administered, Product administered to patient of inappropriate age SMQs:, Medication errors (narrow) Life Threatening? No Birth Defect? No Died? No Permanent Disability? No Recovered? Yes Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (No reported medical history) Allergies: Diagnostic Lab Data: CDC Split Type: USMODERNATX, INC.MOD20210 Write-up: Immunized at age 8; Administered vials that were exposed to room temperature for more than 12 hours; A spontaneous report was received from a physician concerning an 8-year-old patient who received Moderna''s COVID-19 vaccine (mRNA-1273) and experienced the events, immunized at age 8 and administered vials that were exposed to room temperature for more than 12 hours. The patient''s medical history was not provided. Concomitant product use was not provided by the reporter. On 04 Jan 2021, the patient received their first of two planned doses of mRNA-1273 intramuscularly for prophylaxis of COVID-19 infection. On 04 Jan 2021, the patient received a vaccine dose of mRNA-1273 that had been left at room temperature more than 12 hours. It was originally thought that the freezer which stored the mRNA-1273 vaccine died on 04 Jan 2021 at 2am, so vaccine administration occurred up until 2pm. After checking freezer temperature logs, it was discovered the freezer had died at 1:11am. Treatment for the events was not provided. Action taken with mRNA-1273 in response to the events was not provided. The events, immunized at age 8 and administered vials that were exposed to room temperature for more than 12 hours, were considered resolved on 04 Jan 2021.; Reporter''s Comments: This case concerns a 8-year old patient, who was administered the first dose of mRNA-1273 from the vials that were exposed to room temperature for more than 12 hours. This report refers to a case of Product storage error and Product administration error for mRNA-1273, where out of specification product was administered to the patient of inappropriate age. |
|
VAERS ID: |
965149 (history) |
Form: |
Version 2.0 |
Age: |
10.0 |
Sex: |
Unknown |
Location: |
Arizona |
Vaccinated: |
2021-01-21 |
Onset: |
2021-01-21 |
Days after vaccination: |
0 |
Submitted: |
0000-00-00 |
Entered: |
2021-01-22 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / UNK |
UN / UN |
Administered by: Public 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: unknown Current Illness: unknown Preexisting Conditions: unknown Allergies: unknown Diagnostic Lab Data: Unknown CDC Split Type: Write-up: The 10 year old patient, received the Pfizer BioNTech Vaccine; this vaccine is not authorized for use in individuals less than 16 years of age. |
|
VAERS ID: |
970806 (history) |
Form: |
Version 2.0 |
Age: |
11.0 |
Sex: |
Female |
Location: |
Texas |
Vaccinated: |
2021-01-05 |
Onset: |
2021-01-25 |
Days after vaccination: |
20 |
Submitted: |
0000-00-00 |
Entered: |
2021-01-25 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
027620A / 1 |
LA / IM |
Administered by: Pharmacy Purchased by: ? Symptoms: No adverse event SMQs: Life Threatening? No Birth Defect? No Died? No Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: Write-up: No adverse event was reported by the patient. |
|
VAERS ID: |
973749 (history) |
Form: |
Version 2.0 |
Age: |
7.0 |
Sex: |
Male |
Location: |
Unknown |
Vaccinated: |
2021-01-22 |
Onset: |
2021-01-22 |
Days after vaccination: |
0 |
Submitted: |
0000-00-00 |
Entered: |
2021-01-26 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
011L20A / 1 |
UN / IM |
Administered by: Military Purchased by: ? Symptoms: Pain in extremity, Product administered to patient of inappropriate age SMQs:, Tendinopathies and ligament disorders (broad), Medication errors (narrow) Life Threatening? No Birth Defect? No Died? No Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: Write-up: age under 18; sore arm for day 1 post vaccine only, completely resolved by day 2 |
|
VAERS ID: |
976811 (history) |
Form: |
Version 2.0 |
Age: |
7.0 |
Sex: |
Male |
Location: |
Arizona |
Vaccinated: |
2021-01-12 |
Onset: |
2021-01-12 |
Days after vaccination: |
0 |
Submitted: |
0000-00-00 |
Entered: |
2021-01-27 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / UNK |
- / - |
Administered by: Unknown Purchased by: ? Symptoms: Body temperature, Product administered to patient of inappropriate age, Pyrexia SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad) Life Threatening? No Birth Defect? No Died? No Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: Medical History/Concurrent Conditions: Febrile seizure; Pneumonia; Respiratory distress (At birth had persistent respiratory distress requiring oxygen for 10-12 days) Allergies: Diagnostic Lab Data: Test Date: 20210113; Test Name: temperature 101; Result Unstructured Data: Test Result:101 CDC Split Type: USPFIZER INC2021030255 Write-up: temperature 101; vaccine was administered to 7-year-old son; This is a spontaneous report from a Pfizer sponsored program, received from a contactable nurse. This nurse reported similar events for two patients. This is the first of two reports. A 7-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, lot/batch number and expiry date were not provided) solution for injection, via an unspecified route of administration on 12Jan2021 at a single dose for Covid-19 immunization. Medical history included respiratory distress (at birth had persistent respiratory distress requiring oxygen for 10-12 days), Febrile seizure in Jan2017, and pneumonia in Jan2017. The patient''s concomitant medications were not reported. A mother went to get vaccinated for Covid-19. She took her kids ages 7 and 15. The kids were also vaccinated. The vaccine was administered to the 7-year-old son on 12Jan2021. Her son (patient) had a temperature of 101 on 13Jan2021. The mother was concerned because the vaccine was not recommended for his age. She was wondering if he should be in the ER. The reporter does not know if the child still has a fever. She said that the vaccination providers went ahead and gave the vaccine to the children as well even if they were not scheduled to get them. Outcome of the event was unknown. Information of lot/batch number has been requested.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-2021041926 Same reporter, product, and event, different patient |
|
VAERS ID: |
2498904 (history) |
Form: |
Version 2.0 |
Age: |
7.0 |
Sex: |
Male |
Location: |
Unknown |
Vaccinated: |
2021-01-28 |
Onset: |
2021-01-28 |
Days after vaccination: |
0 |
Submitted: |
0000-00-00 |
Entered: |
2021-01-29 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
039K20A / 2 |
LA / IM |
Administered by: Other Purchased by: ? Symptoms: Chills, Headache, Nasal congestion, 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: Headache, Fever, chills, nasal congestion Narrative: |
|