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| VAERS_ID | RECVDATE | STATE | AGE_YRS | CAGE_YR | CAGE_MO | SEX | RPT_DATE | SYMPTOM_TEXT | DIED | DATEDIED | L_THREAT | ER_VISIT | HOSPITAL | HOSPDAYS | X_STAY | DISABLE | RECOVD | VAX_DATE | ONSET_DATE | NUMDAYS | LAB_DATA | V_ADMINBY | V_FUNDBY | OTHER_MEDS | CUR_ILL | HISTORY | PRIOR_VAX | SPLTTYPE | FORM_VERS | TODAYS_DATE | BIRTH_DEFECT | OFC_VISIT | ER_ED_VISIT | ALLERGIES | Link 1 | Link 2 |
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| 1076808 | 03/05/2021 | MD | 15.0 | 15 | M | patient under 16 years of age who received 1st dose of COVID19 vaccine on 12FEB21. patient was 15 years and 9 months at time of vaccination. NOTE: ample information available to patient/guardian on vaccine including FACT SHEET FOR RECIPIENTS AND CAREG | U | 02/12/2021 | 02/12/2021 | 0 | n/a | MIL | unknown | unknown | unknown | 2 | 03/05/2021 | unknown | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1099291 | 03/14/2021 | MD | 15.0 | 15 | M | Patient is out of the FDA range for receiving the vaccine. No side effects have been reported | Y | 03/14/2021 | 03/14/2021 | 0 | PHM | None | None | None | 2 | 03/14/2021 | Peanuts | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1103059 | 03/15/2021 | MD | 15.0 | 15 | F | The patient was under the authorized and recommended age and received the first dose of the Moderna COVID-19 vaccine. Patient was registered for her appointment with an incorrect date of birth. The patient was counseled and given time to ask any questions | U | 03/15/2021 | 03/15/2021 | 0 | OTH | 2 | 03/15/2021 | None listed by patient on immunization consent form. | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1110544 | 03/18/2021 | MD | 15.0 | 15 | F | Client is 15 years of age who got vaccinated. Clientt had no symptoms, side effects or adverse effects immediately after vaccination. Due to her age, client should not have been vaccinated with vaccine. | U | 03/18/2021 | 03/18/2021 | 0 | PUB | 2 | 03/18/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1126313 | 03/23/2021 | MD | 15.0 | 15 | M | Mother filled out Informed Consent Form for Immunization with birthday making patient eligible for Pfizer covid vaccine. After the injection and after patient and mother left store insurance claim rejected for age. I called the mother and she stated that s | U | 03/20/2021 | 03/20/2021 | 0 | none | PHM | none | none | none | 2 | 03/23/2021 | none | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1137519 | 03/26/2021 | MD | 15.0 | 15 | M | Patient is only 15 years of age and should not have received the Moderna vaccine. No adverse affects were noted. | U | 03/25/2021 | 03/25/2021 | 0 | None | PUB | None reported | None reported | Autism | 2 | 03/26/2021 | None reported | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1191300 | 04/10/2021 | MD | 15.0 | 15 | M | At about 15:45 on 04/09/21, a 15 years and 9 months old patient - who had received a first dose of the Pfizer Covid-19 vaccine on 03/19/21 at the clinic - returns to the same location for a second dose of the vaccine as scheduled. Per the parents accompa | U | 03/19/2021 | 03/19/2021 | 0 | N/A | OTH | Unknown | Unknown | Unknown | 2 | 04/10/2021 | Unknown | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1209687 | 04/14/2021 | MD | 15.0 | 15 | F | Patient was under 18 but received Moderna vaccine. | Y | 04/14/2021 | 04/14/2021 | 0 | OTH | 2 | 04/14/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1227007 | 04/18/2021 | MD | 15.0 | 15 | F | Vaccine administered to 15 year old patient. No known symptoms at this time. | U | 04/11/2021 | 04/11/2021 | 0 | PUB | 2 | 04/18/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1229541 | 04/19/2021 | MD | 15.0 | 15 | F | UNDER 16, VACCINE ADMINISTERED | U | 04/15/2021 | 04/15/2021 | 0 | PUB | 2 | 04/19/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1229558 | 04/19/2021 | MD | 15.0 | 15 | F | VACCINATED UNDER THE AGE OF 16 | U | 04/15/2021 | 04/15/2021 | 0 | PUB | 2 | 04/19/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1247438 | 04/23/2021 | MD | 15.0 | 15 | M | was under approved age for pfizer vaccine. was 15 not 16. | U | 04/14/2021 | 04/14/2021 | 0 | PUB | 2 | 04/23/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1267406 | 04/28/2021 | MD | 15.0 | 15 | M | The patient was given a vaccination while he was underage. He did not have any adverse reaction after the vaccination, and felt well. | Y | 04/02/2021 | 04/02/2021 | 0 | none | PUB | none | none | none | 2 | 04/28/2021 | none | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1267420 | 04/28/2021 | MD | 15.0 | 15 | F | The patient was vaccinated underage at 15 years of age. No adverse reaction noted, pt. felt well. | Y | 04/02/2021 | 04/02/2021 | 0 | None | PUB | None | None | None | 2 | 04/28/2021 | None | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1267472 | 04/28/2021 | MD | 15.0 | 15 | F | Patient is 15 years and 1 month. And was given a shot for age 16 and above. | Y | 04/24/2021 | 04/24/2021 | 0 | PHM | N/A | None | None | 2 | 04/28/2021 | None | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1269567 | 04/28/2021 | MD | 15.0 | 15 | M | Administered COVID 19 Vaccine (Pfizer) to a 15 years and 7 months-old male. The HCP looked at the birth year and the handwritten age, determined it was a minor, verified that a parent/guardian signed the consent form, and administered the vaccine. The "5" | U | 04/28/2021 | 04/28/2021 | 0 | SCH | 2 | 04/28/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1291285 | 05/05/2021 | MD | 15.0 | 15 | F | Patient is 15 and received the Pfizer COVID vaccine | 05/01/2021 | 05/01/2021 | 0 | PHM | 2 | 05/05/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1314283 | 05/13/2021 | MD | 14.0 | 15 | M | Pt had spent 10 mins in the observation hall when he w.. as reported to be feeling light-headed and his vision, blurry. Mother reported that he had nothing for breakfast b/4 the vaccination appointment. V/S taken was bp 98/57, rr 14, Hr 80, O2 96% RA, T. 9 | Y | 05/13/2021 | 05/13/2021 | 0 | None | PUB | None | none | None | 2 | 05/13/2021 | NKDA | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1314518 | 05/13/2021 | MD | 15.0 | 15 | F | She c/o dizziness about 5 minutes after vaccination, skin was pale, diaphoretic. She also c/o "not being able to see," for a few seconds. She was brought to observation area, allowed to lie down on cot, vital signs taken, wnl. She was observed for 30 minut | Y | 05/13/2021 | 05/13/2021 | 0 | none | PUB | none | none | none | 2 | 05/13/2021 | none | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1314942 | 05/13/2021 | MD | 15.0 | 15 | F | Itchy rash to arms and legs that immediately resolved with 25mg IM Benadryl. No airway issues. No swelling, no nausea. Observed and Father drove home. | Y | 05/13/2021 | 05/13/2021 | 0 | OTH | None | None | Eczema | 2 | 05/13/2021 | Seasonal | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1320597 | 05/15/2021 | MD | 15.0 | 15 | M | Patient feel dizzy, light headedness, vision changes, observe peel, muscles relax. Did not loose consciousness during brief event, was alert and oriented there after. Escorted by nurse and family member to observation area. observed for 30mins. | Y | 05/15/2021 | 05/15/2021 | 0 | VS: BP 90/50, P 70, R 17 | PUB | NA | NA | NA | 2 | 05/15/2021 | NA | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1321218 | 05/15/2021 | MD | 15.0 | 15 | M | Patient had throat swelling potentially difficulty swallowing. Patient was given Benadryl and patient improved. Reaction occurred 30 minutes after dose. Patient has history of allergies and Asthma and had similar reaction to peanut in past. Vital signs wer | Y | 05/15/2021 | 05/15/2021 | 0 | Vital Signs and pulse ox all normal | OTH | No | Asthma allergies | Asthma allergies | 2 | 05/15/2021 | Y | Yes peanuts and many foods also has asthma | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1322219 | 05/16/2021 | MD | 15.0 | 15 | M | administrative error due to age of patient | 05/15/2021 | 05/15/2021 | 0 | PVT | none | none | none | 2 | 05/16/2021 | none | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1323160 | 05/17/2021 | MD | 15.0 | 15 | F | She got her vaccine, she was sitting in the chair and 4-5 minutes after the shot she started telling her grandfather that she felt nauseated. She then started feeling dizzy and looked like she was going to pass out and he caught her and he laid on her on | N | 05/16/2021 | 05/16/2021 | 0 | As above. | PHM | None. | None. | None. | 2 | 05/17/2021 | Y | None. | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1330471 | 05/19/2021 | MD | 15.0 | 15 | F | Weakness, Nausea. Seen by onsite EMS. 16:23 HR 84 regular Spo2=96% BP=79/55 16:31 Reported symptoms resolved. left with parent. HR 83 regular Spo2=97% BP=105/84 Discharged with mother at 16:35. Recorded by RN. | 05/16/2021 | 05/16/2021 | 0 | OTH | 2 | 05/19/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1330547 | 05/19/2021 | MD | 15.0 | 15 | M | Patient felt nauseous and lightheaded several minutes after receiving vaccine while sitting in chair in observation area. Was given ice pack, water, juice and snack. Taken to health suite via WC and placed on cot, supine with LEs elevated to rest for sever | Y | 05/19/2021 | 05/19/2021 | 0 | none | SCH | None known | Not known | None known | 2 | 05/19/2021 | NKA | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1331194 | 05/19/2021 | MD | 15.0 | 15 | F | Tingling of left arm beginning shortly after vaccination. Reports 0 unusual for her. | 05/19/2021 | 05/19/2021 | 0 | OTH | 2 | 05/19/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1331268 | 05/19/2021 | MD | 15.0 | 15 | F | Was standing passed out and fell to ground. Vital signs: @13:15 B.P=100/50 118/80 HR: 70 Pso2:100% @13:45 B.P. 97/50 Trending hypotension Recorded by staff | 05/19/2021 | 05/19/2021 | 0 | OTH | 2 | 05/19/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1331739 | 05/19/2021 | MD | 15.0 | 15 | M | patient got 0.5 cc instead of 0.3 cc | 05/19/2021 | 05/19/2021 | 0 | PHM | 2 | 05/19/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1331757 | 05/19/2021 | MD | 15.0 | 15 | M | patient got 0.5 cc instead of 0.3cc | U | 05/19/2021 | 05/19/2021 | 0 | PHM | 2 | 05/19/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1331789 | 05/19/2021 | MD | 15.0 | 15 | F | patient got 0.5 cc instead of 0.3 cc | U | 05/19/2021 | 05/19/2021 | 0 | PHM | 2 | 05/19/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1333486 | 05/20/2021 | MD | 15.0 | 15 | M | patient was given 0.5 ml instead of 0.3 ml | U | 05/19/2021 | 05/19/2021 | 0 | PUB | 2 | 05/20/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1333955 | 05/20/2021 | MD | 15.0 | 15 | U | patient reported itching to below arms and chest. This progressed to the upper back area. she denied shortness of breath, trouble breathing or rash. She has no previous reactions to vaccines and did not take this morning. she has allergies to Penicillins | 05/19/2021 | 05/19/2021 | 0 | UNK | 2 | 05/20/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1336489 | 05/21/2021 | MD | 15.0 | 15 | M | PT REPORTED FEELING ANXIUS AND DIZZY, ALSO REPORTS BLURRY VISOIN PT REPORTS FEELING BETTER AFTER ABOUT 5 MIN, HR 80, 96% O2, PT REPORTS SMILAR REACTION TO PREVIOUS VACCIN DID NOT TASKE ANY MEDICATION TODAY PT WAS ENCOURAGE TO LIE FLAT AND TO HYDRATE PT LEF | N | 05/21/2021 | 05/21/2021 | 0 | UNK | 2 | 05/21/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1337854 | 05/21/2021 | MD | 15.0 | 15 | M | Dizziness, pale, vasovagal Discharged home at 10:40 | U | 05/21/2021 | 05/21/2021 | 0 | OTH | 2 | 05/21/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1340795 | 05/22/2021 | MD | 15.0 | 15 | F | Pt. fell to floor from chair, dizziness, possible seizure activity 12 Lead, started IV, 0 meds. Vital signs: 89/40 Pulse:60 89/41 Pulse :55 89/42 Pulse:56 Recorded by RN. Pt. transported to hospital v | 05/22/2021 | 05/22/2021 | 0 | OTH | 2 | 05/22/2021 | Y | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1340897 | 05/22/2021 | MD | 15.0 | 15 | F | Nausea Seen by EMS, Pt. left in stable condition at 12:06 | 05/22/2021 | 05/22/2021 | 0 | OTH | 2 | 05/22/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1342022 | 05/23/2021 | MD | 15.0 | 15 | F | chest tightness, none, lasted a few minutes, but occurred again a couple of hours later. | Y | 05/22/2021 | 05/23/2021 | 1 | none | PUB | none | none | none | 2 | 05/23/2021 | none | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1342106 | 05/23/2021 | MD | 15.0 | 15 | M | Sudden hearing loss in Left Ear -15 db to -55 db depending on frequency. Most loss in 500Hz to 1000Hz range. Visited 2 ENT Dr for audiology tests. Recommendation/prescription 60mg daily Prednisone tablets for 7 days, 40mg daily for next 3 days, 20mg for | Y | N | 05/18/2021 | 05/19/2021 | 1 | 5/20/2021 ENT Care - Hearing test 5/21/2021 ENT Care - Hearing test | PHM | None | None known | 2 | 05/23/2021 | Y | Mold, Cat Dander, Pollen | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1346774 | 05/25/2021 | MD | 15.0 | 15 | F | Under age 16 | 04/28/2021 | 04/28/2021 | 0 | UNK | 2 | 05/25/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1346805 | 05/25/2021 | MD | 15.0 | 15 | M | Vaccine administered to 15yo before EUA | 04/17/2021 | 04/17/2021 | 0 | UNK | 2 | 05/25/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1346816 | 05/25/2021 | MD | 15.0 | 15 | M | Vaccine administered to 15yo before EUA | 05/08/2021 | 05/08/2021 | 0 | UNK | 2 | 05/25/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1346826 | 05/25/2021 | MD | 15.0 | 15 | M | Vaccine administered to 15yo before EUA | 04/25/2021 | 04/25/2021 | 0 | UNK | 2 | 05/25/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1346861 | 05/25/2021 | MD | 15.0 | 15 | F | Vaccine administered to 15yo before EUA | 05/10/2021 | 05/10/2021 | 0 | UNK | 2 | 05/25/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1359053 | 05/28/2021 | MD | 15.0 | 15 | M | Weak and tired. He felt like he was numb. Like he couldn't really move. He slept - didn't have any fever. Was really hot though. He had a really bad headache and his dad gave him Tylenol. He felt still tired the next day but felt better. The headache was g | Y | 05/18/2021 | 05/18/2021 | 0 | 20th -facility labs - bloodwork - some numbers were low - white blood count 3.0 - low; MID % - high - 7.0; GRAN - 1.3 (low): MID - low 0.2 - they will check him again in a couple of months. | PHM | no | no | Baby Marrows Issues when he was born - his labs were so low when he was 4 years old that he had to get medication to get his white blood cell count to go back up to normal - but for the last two years he hasn't had any problem | vsafe | 2 | 05/28/2021 | Y | no | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1361792 | 05/30/2021 | MD | 15.0 | 15 | M | Six days (evening of 5/20) after the first dose of the COVID vaccine (Pfizer), Patient started to experience severe dizziness and nausea. Since that evening he has experienced the following: - Significant increase in heart rate when transitioning from layi | Y | N | 05/13/2021 | 05/20/2021 | 7 | Patient has been seen multiple times since the onset of the symptoms. He has been to the ER. We were advised by his pediatrician to have him be seen by a pediatric cardiologist immediately for suspected PoTS. patient was 100% healthy with NO chronic cond | PHM | Claritin, Lexapro 5mg | None | None | 2 | 05/30/2021 | Y | Y | Allergic to penicillin | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1365181 | 06/01/2021 | MD | 15.0 | 15 | M | Developed chest pain radiates to spine shortness of breath due to chest pain | Y | 05/15/2021 | 05/16/2021 | 1 | None | PUB | None | History of arachnoid cyst with subdural hygroma | 2 | 06/01/2021 | None | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1365515 | 06/01/2021 | MD | 15.0 | 15 | M | Mostly nonverbal pt developed temp 100-102 evening following vaccine through following day, and on day 3 had significant chest pain warranting 911 call and ED visit. Labs were significant for leukocytosis (WBC 19.8) and CXR w R hilar pneumonia. Troponin | Y | 05/27/2021 | 05/27/2021 | 0 | WBC 19.8 w 86% neutrophils. CRP 25. Troponin <0.010, CMP unremarkable, lipase 13, CXR w R infrahilar opacity. | UNK | Singulair, albuterol, Miralax, Pepcid, Albuterol prn | Was seen at my office for ear pain 5/25/21 and was found to have cerumen impaction. | Down Syndrome, recurrent otitis media, asthma, recurrent suppurative adenitis | 2 | 06/01/2021 | Y | Y | Cephalosporins, Augmentin (rash) | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1365913 | 06/01/2021 | MD | 15.0 | 15 | F | NO ADVERSE EVENTS ADMINISTERED PRIOR TO CDC APPROVAL | 05/11/2021 | NONE | PHM | 2 | 06/01/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1365928 | 06/01/2021 | MD | 15.0 | 15 | F | ADMINISTERED PRIOR TO CDC APPROVAL | 05/11/2021 | 05/11/2021 | 0 | PHM | 2 | 06/01/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1365950 | 06/01/2021 | MD | 15.0 | 15 | F | ADMINISTERED PRIOR TO CDC APPROVAL | 05/11/2021 | 05/11/2021 | 0 | PHM | 2 | 06/01/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1367892 | 06/02/2021 | MD | 15.0 | 15 | M | ADMINISTERED PRIOR TO CDC APPROVAL | 05/11/2021 | 05/11/2021 | 0 | PHM | 2 | 06/02/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1368169 | 06/02/2021 | MD | 15.0 | 15 | M | Weakness/ Lethargic Seen by EMS on site PR 52 SPO2 100% BP 88/35 BP at 10:20am 101/57 | 06/02/2021 | 06/02/2021 | 0 | OTH | 2 | 06/02/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1371117 | 06/03/2021 | MD | 15.0 | 15 | F | patient reports anxiety. heart rate was 100. patient asked to drink water, relax laid down with feet up. reassessed after 20 minutes. heart rate was down to 69 and oxygen 99%. | 05/28/2021 | 05/28/2021 | 0 | UNK | 2 | 06/03/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1375063 | 06/04/2021 | MD | 15.0 | 15 | M | Systemic: Fainting / Unresponsive-Mild, Additional Details: Patient fainted, but was still awake and responsive, just lightheaded. Patient left on own accord after interaction with paramedics | Y | 06/04/2021 | 06/04/2021 | 0 | PHM | 2 | 06/04/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1375923 | 06/04/2021 | MD | 15.0 | 15 | F | Low- grade fever 99.3, body aches, chills, headache | N | 06/03/2021 | 06/04/2021 | 1 | None at this time | OTH | Tylenol | None | None | 2 | 06/04/2021 | None | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1377313 | 06/07/2021 | MD | 15.0 | 15 | M | 6/2/2021 abdominal pain with fever, diagnosis appendicitis. 6/3/2021 appendectomy | Y | 05/23/2021 | 06/02/2021 | 10 | 6/2/2021 CBC showed elevated white count. 6/3/2021 CT with oral contrast confirmed appendicitis. 6/3/2021 appendectomy | SCH | none | none | none | 2 | 06/07/2021 | penicillin | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1378081 | 06/07/2021 | MD | 15.0 | 15 | M | Initially had headache and chills after vaccine, on day 3 after vaccine developed chest pain (midsternal and worse with inspiration), had one episode of emesis. On admission to hospital had elevated troponin, pro-BNP, Crp, normal EKG but echo consistent wi | Y | 3 | U | 06/03/2021 | 06/06/2021 | 3 | Echo 6/6/21: 1. Low normal left ventricular systolic function (biplane EF = 58.9 % and 3D EF = 55.37 %). 2. Trivial tricuspid valve regurgitation. 3. Trivial mitral v | OTH | Per parent report: Gummy vitamins, fish oil vitamin, "cream for acne on back", soap for psoriasis, Zyrtec, occasional ibuprofen for headache | None | Acne, seasonal allergies | 2 | 06/07/2021 | Y | Hives with sulfa medications | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1378488 | 06/07/2021 | MD | 15.0 | 15 | M | Patient describes feeling dizzy, having visual trouble immediately receiving the vaccine, then slid onto the floor from the chair he was sitting on. Presents with mother who denies him hitting his head. LOC lasted 1-2 minutes before he was able to be rouse | Y | 06/07/2021 | 06/07/2021 | 0 | n/a | PUB | Nothing | Denies | None | 2 | 06/07/2021 | None | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1384870 | 06/09/2021 | MD | 15.0 | 15 | M | Patient reports feeling light headed with headache. denied shortness of breath, dyspnea, hives or itchiness. Patient educated to lay flat with feet up. Also encouraged to drink water to stay hydrated. after few minutes symptoms subsided. | 06/08/2021 | 06/08/2021 | 0 | UNK | 2 | 06/09/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1385115 | 06/09/2021 | MD | 15.0 | 15 | F | Anxiety, hyperventilation-States "common when getting injections." (1st injection at AACO-DOH on 5/15/2021 EW0183) @14:23 HR=80 SPO2=100% BP=114/65 @14:32 HR=78 SPO2=100% BP=112/74 @14:35 Left vaccine clinic | 06/05/2021 | 06/05/2021 | 0 | OTH | 2 | 06/09/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1385227 | 06/09/2021 | MD | 15.0 | 15 | F | Feeling nausea, HOH after injection she stated. Same s/s after 1st injection she stated. @16:34 BP=71/38 Pulse=67 O2=97% @16:38 BP=76/47 Pulse=64 O2=97% @16:43 BP=90/61 Pulse=67 | 06/06/2021 | 06/06/2021 | 0 | OTH | 2 | 06/09/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1388053 | 06/10/2021 | MD | 15.0 | 15 | M | hives on injection site, on 6/8 and again on 6/10. Hives went away with Zyrtec | Y | 06/04/2021 | 06/08/2021 | 4 | PUB | none | none | exercise-induced asthma, history of allergic reactions/anaphylaxis with unknown cause (two times about 6/7 years ago). | 2 | 06/10/2021 | amoxicillan | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1388537 | 06/10/2021 | MD | 15.0 | 15 | M | On June 10, 2021 around 1:20am, child woke me up and stated that he has a headache. After feeling his head, he felt very warm with a temperature of 102.3 using both a digital and under the tongue thermometers. I had child to take a Tylenol pill with som | U | 06/09/2021 | 06/10/2021 | 1 | None | OTH | None | None | Asthma | Sore Arm | 2 | 06/10/2021 | Food allergies to crabs, shrimps, peanut butter, Tilapia fish. | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1395407 | 06/14/2021 | MD | 15.0 | 15 | M | NONE | 06/07/2021 | 06/08/2021 | 1 | UNK | Heartburns. Very uncomfortable. | none | none | 2 | 06/14/2021 | none | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1395430 | 06/14/2021 | MD | 15.0 | 15 | F | Administration of vaccine began at 10:46am. At 10:48, patient was observed to be pale, complained of being light headed, and was observed to be diaphoretic. Pediatric resident was called at 10:48 and was in attendence through observation event. She was p | 06/11/2021 | 06/11/2021 | 0 | UNK | 2 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1400206 | 06/15/2021 | MD | 15.0 | 15 | F | Patient began feeling nauseous and light-headed post-vacccination. EMS evaluated her and determined that her blood pressure was low. Patient was given water, snacks, and a cold compress. 6/1/21: 11:47am - TC to parent. No answer. left message to call back | U | 05/18/2021 | 05/18/2021 | 0 | PUB | 2 | 05/27/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1402215 | 06/16/2021 | MD | 15.0 | 15 | M | On 6/8, he developed fever and chills. On 6/9, he developed shortness of breath, dizziness, increased HR while playing golf. Rested and symptoms improved. Resting HR at the time of my call with him was in the 80s, but he reported low 100s when he was playi | Y | 06/07/2021 | 06/09/2021 | 2 | none | UNK | 2 | 06/16/2021 | none | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1407820 | 06/17/2021 | MD | 15.0 | 15 | F | child only 15 | U | 05/20/2021 | 05/20/2021 | 0 | PUB | 2 | 06/17/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1431116 | 06/28/2021 | MD | 15.0 | 15 | M | 15 year old male here with grandmother due to concerns regarding chest pain and shortness of breath. Received the 2nd dose of Pfizer vaccine 4 days ago. That evening had body aches, chills, fever and shortness of breath. The other symptoms resolved the n | Y | 06/23/2021 | 06/23/2021 | 0 | UNK | Asthma | 2 | 06/28/2021 | Y | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1433790 | 06/29/2021 | MD | 15.0 | 15 | M | Patient received #1 dose of Pfizer vaccine today 6/29/2021 at 1:47 pm. Patient spent 15 minutes in observation room without exhibiting any signs or symptoms of any adverse reaction. Patient left observation room with parent and siblings and entered eleva | U | 06/29/2021 | 06/29/2021 | 0 | n/a | WRK | none | none | ADHD | 2 | 06/29/2021 | Y | NKA | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1443134 | 07/02/2021 | MD | 15.0 | 15 | M | Dizziness, lightheadedness, and hypotension to 82/51 | N | 06/29/2021 | 07/01/2021 | 2 | Hgb: 14/0 g/dL HCT: 41% Heart rate: 87 Physical exam within normal except for R big toe ingrown toenail and healing paronychia. | PVT | None | Ingrown toenail with local infection ~1 week prior to vaccination | Asthma | 2 | 07/02/2021 | Y | NKA | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1443258 | 07/02/2021 | MD | 15.0 | 15 | M | Approximately 10 min after receiving vaccine, pt experienced vasovagal episode. Became faint, lightheaded, and complained of headache. | Y | 07/02/2021 | 07/02/2021 | 0 | None | PVT | None | None | None | Mother reports h/o vasovagal reactions after other vaccines. | 2 | 07/02/2021 | Y | None | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1454279 | 07/07/2021 | MD | 15.0 | 15 | M | headache for 5 days straight took tylenol | Y | 06/22/2021 | 06/22/2021 | 0 | PHM | 2 | 07/07/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1467015 | 07/13/2021 | MD | 15.0 | 15 | M | On June 2, 2021, he awoke and complained of feeling hot, tired, and not hungry. His mother had been sick with acute gastroenteritis symptoms 2 days earlier. Over the course of the day, he had a fever to 101.6 F, and began to have loose stools (twice). He r | Y | 1 | Y | 05/13/2021 | 06/02/2021 | 20 | Initial labs in the local ER showed a Troponin I High Sensitivity of 2,508.1 ng/L, B Type Natriuretic Peptide of 196.0 pm/mL, CRP of 7.2 mg/dL, and D-Dimer of 660 ng/mL. WBCs were normal (8.08 k/mcL) with 50% segs, 10% bands, 26% lymphs, and 12% monos. Ch | OTH | None | Rhinorrhea and nasal congestions (seasonal allergies) treated with Cetirizine 10 mg by mouth once a day. Not taking at the time of vaccination. | Autism Spectrum Disorder, obesity, anaphylaxis (peanuts, tree nuts, shellfish), and seasonal allergies | 2 | 07/13/2021 | Y | Anaphylaxis to peanuts, tree nuts, and shellfish. No known drug allergies. | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1474045 | 07/15/2021 | MD | 15.0 | 15 | M | Error: Patient Too Young for Vaccine Administered- | Y | 05/09/2021 | 05/09/2021 | 0 | PHM | 2 | 07/15/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1487317 | 07/20/2021 | MD | 15.0 | 15 | M | chest pain, shortness of breath | Y | 1 | Y | 06/27/2021 | 07/17/2021 | 20 | Administered morphine for pain with improvement. Obtained troponin and BNP, troponin elevated to 0.1 (normal upper limit 0.05) and BNP 23. Transferred for further evaluation given elevated troponiN. PE unremarkable. Chest pain and difficulty breathing res | PHM | minocycline | cold symptoms, cannot remember timeline but in the month prior to vaccination | none | 2 | 07/20/2021 | none | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1490578 | 07/21/2021 | MD | 15.0 | 15 | F | ?Describe the adverse events, treatment, and outcomes?: enter: ?Patient received vaccine that was stored improperly. Vaccine was moved from ultra-cold freezer to freezer on 6/17/21. According to guidance from Pfizer, vaccine stored in the freezer after day | U | 07/06/2021 | 07/06/2021 | 0 | PHM | 2 | 07/21/2021 | None | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1501282 | 07/25/2021 | MD | 15.0 | 15 | F | n/a | Y | 04/25/2021 | 05/16/2021 | 21 | PHM | mother who lies about her kid's age | 2 | 07/25/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1519267 | 08/02/2021 | MD | 15.0 | 15 | F | Acute onset chest pain, increased work of breathing and hypoxia requiring BiPAP. CT scan with bilateral ground glass opacities of unclear etiology | Y | 4 | N | 07/10/2021 | 07/29/2021 | 19 | Respiratory Viral Panel, COVID test - negative | PVT | Acetazolamide; Iron Supplement | Diagnosed with idiopathic intracranial hypertension 1 month prior (07/02/2021) | Obesity | 2 | 08/02/2021 | Y | None | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1525741 | 08/04/2021 | MD | 15.0 | 15 | F | Pt received a Covid Pfizer vaccine today at pharmacy and is few moments later passed out while sitting in her chair. Paramedics were called and her VS and BG were normal. Pt's mom declined ER visit . Pt went to PCP for F/U and vital signs were normal , EKG | Y | 08/04/2021 | 08/04/2021 | 0 | VS normal, BG 123, EKG normal | UNK | 2 | 08/04/2021 | Y | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1530448 | 08/06/2021 | MD | 15.0 | 15 | M | below freezing temperature excursion; This case was reported by a physician via call center representative and described the occurrence of incorrect storage of drug in a 15-year-old male patient who received HAV (Havrix) (batch number yl532, expiry date 9t | U | 07/16/2021 | UNK | USGLAXOSMITHKLINEUS202116 | 2 | 08/05/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1545973 | 08/11/2021 | MD | 15.0 | 15 | F | Daughter had seizure within minutes of receiving vaccine and then passed out | Y | 08/11/2021 | 08/11/2021 | 0 | PHM | 2 | 08/11/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1586815 | 08/19/2021 | MD | 15.0 | 15 | F | Patient describes the onset of sharp stinging pain in the left elbow when bending/extending the elbow. Pronating and supinating forearm did not cause pain. Pain was described as intense, "lightning bolt" pain severe enough to cause tears. No redness, sw | Y | 08/04/2021 | 08/05/2021 | 1 | x rays two views of left elbow were normal | PVT | none | none | none | 2 | 08/19/2021 | Y | none | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1591234 | 08/20/2021 | MD | 15.0 | 15 | F | Event occurred > 30 days but < 60 days since vaccine administration. Severe unanticipated event in otherwise healthy 15 yo First dose 6/1/21 (Pfizer) Neurological - Evaluated for stroke; Dizziness,Headache,Loss of consciousness,Seizure Hemorrhagic stroke | Y | Y | 06/28/2021 | 08/18/2021 | 51 | 8/18/21 CT head - acute bleed | PVT | 2 | 08/20/2021 | Y | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1637616 | 08/26/2021 | MD | 15.0 | 15 | F | Extreme cramping and bleeding with period. | N | 08/25/2021 | 08/26/2021 | 1 | UNK | None | None | None | 2 | 08/26/2021 | None | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1675405 | 09/06/2021 | MD | 15.0 | 15 | F | Systemic: Chest Tightness / Heaviness / Pain-Mild, Additional Details: patient said after approx 10 minutes she experenced mild to moderate chest heavieness with slight difficulty breathing. patient stated she has a history of asthma. she said it had impro | Y | 08/04/2021 | 08/04/2021 | 0 | PHM | 2 | 09/06/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1689517 | 09/10/2021 | MD | 15.0 | 15 | F | PT DEVELOPED DYSFUNCTIONAL UTERINE BLEEDING SOON AFTER RECEIVING THE VACCINE WHICH LASTED FOR 4 WEEKS REQUIRING A HOSPITAL VISIT FOR A HEMOGLOBIN OF 6. | Y | 06/25/2021 | 06/27/2021 | 2 | HEMOGLOBIN 6 HEMATOCRIT 20 | PHM | 2 | 09/10/2021 | Y | Y | TREE POLLEN | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1690130 | 09/10/2021 | MD | 15.0 | 15 | F | Extreme chills, migraine, fever,and nausea. We gave her ibuprofen and have her under a heating blanket. She is sipping water. | N | 09/10/2021 | 09/10/2021 | 0 | Nothing yet | MIL | None | None | None | 2 | 09/10/2021 | None | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1708924 | 09/17/2021 | MD | 15.0 | 15 | F | prolonged menstrual bleeding | U | 06/16/2021 | 07/01/2021 | 15 | PVT | 2 | 09/17/2021 | Y | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1709654 | 09/17/2021 | MD | 15.0 | 15 | M | PATIENT FELT FAINT APPROXIMATELY 3-5 MINUTES FOLLOWING 2ND DOSE OF PFIZER COVID VACCINE. PATIENT BEGAN TO FAINT AND FATHER LOWERED HIM TO THE FLOOR. PATIENT QUICKLY REGAINED CONSCIOUSNESS, BUT FELT FAINT AFTER GETTING BACK IN A CHAIR. PATIENT WAS LOWERED T | Y | 09/17/2021 | 09/17/2021 | 0 | BLOOD PRESSURE 106/60 AT FIRST, THEN 110/70 ABOUT 10 MINS LATER. O2 SAT LEVEL 100%. HEART RATE APPROXIMATELY 90. BLOOD GLUCOSE 81. | PHM | UNKNOWN | UNKNOWN | UNKNOWN | 2 | 09/17/2021 | NONE | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1713617 | 09/18/2021 | MD | 15.0 | 15 | F | patient was given moderna covid- 19 vaccine instead of pfizer vaccine | U | 08/16/2021 | 08/16/2021 | 0 | none | PHM | UNKOWN | UNKNOWN | UNKNOWN | 2 | 09/18/2021 | NO ALLERGY | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1714980 | 09/20/2021 | MD | 15.0 | 15 | F | Patient received her 2nd dose of Moderna despite being 15 years old. This is because for her 1st shot (RX 7614085) she received Moderna erroneously. To maintain continuation of care the CDC recommends she receive another dose of Moderna. | 09/16/2021 | 09/16/2021 | 0 | PHM | 2 | 09/20/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1730961 | 09/24/2021 | MD | 15.0 | 15 | F | Systemic: Dizziness / Lightheadness-Medium, Systemic: Exhaustion / Lethargy-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Mild, Systemic: Hyperventilation-Medium, Systemic: Nausea-Medium, Systemic: Visual Changes/Disturbanc | Y | 09/23/2021 | 09/23/2021 | 0 | PHM | 2 | 09/24/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1778909 | 10/12/2021 | MD | 15.0 | 15 | M | We are not sure if it's due to the vaccine or not (since it has been 4 months since the 2nd dose). But here are symptoms: a. Persistent Low-grade Fever (on and off between 99.5 - 100.5, since last 30 days and counting) b. Extreme Tiredness/Fatigued c. Dizz | N | 06/04/2021 | 09/20/2021 | 108 | All tests below were unremarkable and no findings so far. The list is chronological order latest at top. 1. 20211009-PCR-TSH-T4 2. 20210930-CBC-Stool-Urine-Fungal-CRP-Antibody 3. 20210930-CT_Scan_Reports (Head, Chest, Abdomen) 4. 20210930-PCR 5. 20210928-C | PHM | None | None | None | 2 | 10/12/2021 | Y | None | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1830710 | 10/30/2021 | MD | 15.0 | 15 | M | Tightness of chest; Wheezing; Fatigue; This spontaneous case was reported by a consumer and describes the occurrence of CHEST DISCOMFORT (Tightness of chest), WHEEZING (Wheezing) and FATIGUE (Fatigue) in a 15-year-old male patient who received mRNA-1273 (M | U | 04/22/2021 | UNK | USMODERNATX, INC.MOD20213 | 2 | 10/29/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX |