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You are viewing patients aged: 16, in state: WI

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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
0919637	01/04/2021	WI	16.0	16		F		No adverse reaction - vaccine was administered to a employee that was 17 years of age									Y	01/04/2020	01/04/2020	0		PHM							2	01/04/2021					2021VAERSSYMPTOMS	2021VAERSVAX
0923844	01/06/2021	WI	16.0	16		F		Patient had completed the VAR form prior to the clinic. Staff was aware that only ages 18 and over could get immunization. They allowed her to have the shot with parental approval, which we as the vaccinators did not notice or approve of.									U	01/05/2021	01/05/2021	0		SEN							2	01/06/2021					2021VAERSSYMPTOMS	2021VAERSVAX
0923913	01/06/2021	WI	16.0	16		F		Patient was given the immunization despite her being outside of the appropriate age range. Patient and workplace had signed VAR stating they were 18 years old and able to receive the vaccine. Immunizing staff wasn't aware of her age due to the fact that t									U	01/05/2021	01/05/2021	0		SEN							2	01/06/2021					2021VAERSSYMPTOMS	2021VAERSVAX
0943805	01/14/2021	WI	16.0	16		F		Error: Booster Given Too Early									Y	01/05/2021	01/05/2021	0		WRK							2	01/14/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1039037	02/18/2021	WI	16.0	16		F		Error: Patient Too Young for Vaccine Administered									Y	02/16/2021	02/16/2021	0		WRK							2	02/18/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1040157	02/18/2021	WI	16.0	16		F		A minute after receiving vaccine, client lost consciousness for approximately 30 seconds paired with facial twitching. No history of seizures and history of syncope due to holding breath and anxiety with medical procedures and vaccinations in the past.EMS									Y	02/18/2021	02/18/2021	0		PUB				Hx of syncope due to anxiety and holding breath related to medical procedures			2	02/18/2021				Hx of anaphylaxis due to cashews and pistachios	2021VAERSSYMPTOMS	2021VAERSVAX
1049896	02/23/2021	WI	16.0	16		F		Patient did not qualify for vaccine. She is 16 and she is a lifeguard.									U	02/23/2021	02/23/2021	0		PVT							2	02/23/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1052312	02/24/2021	WI	16.0	16		F		Error: Patient Too Young for Vaccine Administered									Y	12/28/2020	12/28/2020	0		SEN							2	02/24/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1086515	03/09/2021	WI	16.0	16		M		None									Y	02/25/2021	02/25/2021	0		PHM		None	None	None			2	03/09/2021				None	2021VAERSSYMPTOMS	2021VAERSVAX
1091080	03/11/2021	WI	16.0	16		F		Client somehow made an appointment for a clinic, and is not the recommended age for this vaccine.									Y	02/10/2021	02/10/2021	0		PUB		unknown	unknown	unknown			2	03/11/2021				unknown	2021VAERSSYMPTOMS	2021VAERSVAX
1091136	03/11/2021	WI	16.0	16		F		Client somehow scheduled an appointment for a Moderna clinic and is not the recommended age for this vaccine.									Y	03/10/2021	03/10/2021	0	N/A	PUB		unknown	unknown	unknown			2	03/11/2021				unknown	2021VAERSSYMPTOMS	2021VAERSVAX
1092257	03/11/2021	WI	16.0	16		M		Patient is 16 years old, Moderna is only approved for ages 18 or older									Y	03/11/2021	03/11/2021	0		PHM		None	No known illnesses at time of vaccination	None noted			2	03/11/2021				NKDA	2021VAERSSYMPTOMS	2021VAERSVAX
1123282	03/22/2021	WI	16.0	16		M		Administration error: Pt. was younger than the age authorized for Janssen vaccine. Pt. had no adverse reaction to the vaccine.									Y	03/13/2021	03/13/2021	0		PUB							2	03/22/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1130563	03/24/2021	WI	16.0	16		F		Janssen vaccine given to a 16 year old.									U	03/17/2021	03/17/2021	0	none	PUB							2	03/24/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1136102	03/25/2021	WI	16.0	16		F		Patient seemed fine immediately after the vaccine and walked to a nearby chair to wait for 15 minutes for observation. I was alerted by the pharmacy technician I was needed outside of the immunization room and patient had vomited. It seemed to be mostly st									Y	03/25/2021	03/25/2021	0	none	PHM		unknown	unknown	unknown			2	03/25/2021				none reported	2021VAERSSYMPTOMS	2021VAERSVAX
1145210	03/29/2021	WI	16.0	16		F		Pt is only 16 years old and received Moderna for 1st dose of COVID-19 vaccine. No adverse effects, just error in administration. Moderna was notified and states is ok to give 2nd injection as off label use to complete the series.									Y	03/29/2021	03/29/2021	0	NA	PVT							2	03/29/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1148103	03/30/2021	WI	17.0	16		F		Immediate vasovagal reaction. Recovered with supine positiion. Vital signs were monitored. Was able to sit after 15 minutes, then stand and walk after 15 more minutes of observation									Y	03/01/2021	03/01/2021	0	none	WRK					Vasovagal syncope		2	03/30/2021				none	2021VAERSSYMPTOMS	2021VAERSVAX
1155527	04/01/2021	WI	16.0	16		F		They made initial contact with young lady when she entered the holding area (as they do with every car). Their second contact came when the mother showed up on scene. At that time the patient reported that at one point her vision began to get dark on t									Y	03/31/2021	03/31/2021	0	none	OTH		unknown	unknown	unknown			2	04/01/2021				unknown	2021VAERSSYMPTOMS	2021VAERSVAX
1156210	04/01/2021	WI	16.0	16		F		Patient received the Moderna vaccine under the age of 18. Per guidance she was admistered the 2nd dose.									Y	02/23/2021	02/23/2021	0		PVT							2	04/01/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1159312	04/02/2021	WI	16.0	16		F		Headache, fever to 103, body aches, and fatigue. Treated with fluids and rest									U	03/31/2021	03/31/2021	0		PVT							2	04/02/2021		Y			2021VAERSSYMPTOMS	2021VAERSVAX
1159911	04/02/2021	WI	16.0	16		F		Vasovagal Syncope. Awake within 3 seconds, kept her legs elevated, pushed fluids and a snack. Patient was given the Moderna Vaccine and is under the age of 18									Y	03/20/2021	03/20/2021	0		PVT		Vitamin D3 1000IU Sprintec 0.25mg-35mcg Children's Multivitamin Sertraine 100mg	None	Depressive Disorder			2	04/02/2021				No known Allergies	2021VAERSSYMPTOMS	2021VAERSVAX
1159957	04/02/2021	WI	16.0	16		F		Received the Moderna Vaccine under the age of 18									Y	03/23/2021	03/23/2021	0		PVT		Differin 0.1% Topical gel Albuterol CFC free 90mcg.inh Vitamin C 500mg Calcium carbonate 500mg Doxycycline hyclate 50mg Loratadine 10g Melatonin 10mg Warfarin		Chronic thromboembolic pulmonary hypertension, s/p pulmonary thromboembolectomy (10/2020), antipospholipid syndrome. mild right ventricular dysfunction Pulmonary Emboli			2	04/02/2021				No Known Medication Allergies Environmental Allergies	2021VAERSSYMPTOMS	2021VAERSVAX
1160739	04/02/2021	WI	16.0	16		M		8 days of intermittent fevers 101-106 (ongoing), rigors, chills and fatigue. Started 24 hours after COVID vaccine. This is ongoing, day 8 and fever still 101+ without ibuprofen. Seen twice at PCP's office listed above (seen by Dr. and Dr. this week but D									N	03/25/2021	03/26/2021	1	CRP elevated at 18, ESR 33, mild hemolyzed blood in urine, large platelets on CBC, WBC 14, normal hemoglobin, platelets 273-300, and elevated D Dimer. Negative UA and negative blood cultures x 2. Started 24 hours after COVID vaccine. COVID test negative (	PVT		Multi Vitamin, Vitamin D	None	intermittent migraines			2	04/02/2021				None	2021VAERSSYMPTOMS	2021VAERSVAX
1168309	04/05/2021	WI	16.0	16		F		Client was 16 years old when she received Moderna vaccine (dose 1). Client and parent notified and parent denies any adverse reactions. Client and parent educated that off label use for Moderna would be for client to receive 2nd dose of series. Parent in a										03/24/2021	03/24/2021	0		UNK							2	04/05/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1171289	04/06/2021	WI	16.0	16		F		Patient was accompanied by mother for her Pfizer COVID-19 vaccine. After recieving her vaccine, she told her mother that her hands were feeling 'different.' Mother attempted to walk patient over to nurse's vaccine bay. Patient then became faint and was low									Y	04/05/2021	04/05/2021	0		PVT		none	none	none			2	04/06/2021				none	2021VAERSSYMPTOMS	2021VAERSVAX
1177223	04/07/2021	WI	16.0	16		F		This event was an administration error. The Moderna vaccine was administered to an individual under the age of 18. Patient tolerated the vaccine administration, and no adverse reactions have been reported.										03/09/2021	03/09/2021	0		PVT							2	04/07/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1177245	04/07/2021	WI	16.0	16		M		Was given shot at the age of 16. This shot is currently recommended for 18 years or older.									U	03/31/2021	03/31/2021	0		PHM							2	04/07/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1184812	04/09/2021	WI	16.0	16		M		PHN supervisor was notified by state that this patient was below the age requirement to receive this vaccine. PHN contacted the patient's mother and notified her of this information. Patient's mother states that the child appears without any complaints or									U	03/22/2021	03/22/2021	0	n/a	OTH		unknown	unknown	unknown			2	04/09/2021				unknown	2021VAERSSYMPTOMS	2021VAERSVAX
1197195	04/12/2021	WI	16.0	16		F		Client was administered Janssen vaccine at a clinic. Client was not of the required age of 18 and older.									Y	04/07/2021	04/07/2021	0		PUB							2	04/12/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1197917	04/12/2021	WI	16.0	16		F		Patient has a history of dizziness, headaches and Tourette's syndrome. Immediate complaints of headache, nausea, arm tenderness and being dizzy. Patient was laid down, given water and a snack. She was discharged with her parents after 30 min of observatio									Y	04/08/2021	04/12/2021	4	none	PVT		Drospirenone, Adapalene, Guafacine, Ibuprofen, citrizine	migraines	Tourrettes Syndrome			2	04/12/2021				none	2021VAERSSYMPTOMS	2021VAERSVAX
1198137	04/12/2021	WI	16.0	16		M		Patient who received vaccination was 16 years old. Interviewed dad. reports that patient had a mildly sore arm for a day and denies any other side effects, issues, or concerns.									Y	04/07/2021	04/07/2021	0	None	PUB		NONE	No	No			2	04/12/2021				NONE	2021VAERSSYMPTOMS	2021VAERSVAX
1203690	04/13/2021	WI	16.0	16		F		Inadvertently was given Janssen vaccine at age 16. Patient's mother reports that Avery had fever of 101, fatigue, and 'flu like' symptoms which fully resolved by April 3. Avery has been feeling well since.									Y	03/31/2021	03/31/2021	0	None	PUB		Unknown	None known	Unknown			2	04/13/2021				Unknown	2021VAERSSYMPTOMS	2021VAERSVAX
1225942	04/18/2021	WI	16.0	16		F		Patient was a 16yr female who received Pfizer vaccine 3/19/21 at vaccine clinic and presented with ongoing CPR to the ED 3/28/21 after cardiac arrest at home. Patient placed on ECMO and imaging revealed bilateral large pulmonary embolism as likely etiology	Y	03/30/2021							N	03/19/2021	03/28/2021	9		UNK		Reported to be on Drospirenone-Ethinyl Estradiol 3-0.02 MG per tab					2	04/18/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1247408	04/23/2021	WI	16.0	16		F		Patient was registered under a parent's DOB and was administered the moderna vaccine LOT Number 046A21A by a volunteer physician. The patients of this vaccination clinic were scheduled by a partner organization and the mobile vaccine site. The date of bir									Y	04/20/2021	04/20/2021	0		PVT		N/A	N/A	N/A			2	04/23/2021				N/A	2021VAERSSYMPTOMS	2021VAERSVAX
1267991	04/28/2021	WI	16.0	16		M		Received his 2nd Pfizer Covid-19 vaccine today and while waiting the 15 minute observation time, he had a witnessed syncopal episode. Writer noticed him and lowered him to the floor out of his chair. He did not hit his head, nor have any injury. He quickly									Y	04/26/2021	04/26/2021	0		PVT		None	None	None	mom states at younger age; same incident following vaccine		2	04/28/2021				None	2021VAERSSYMPTOMS	2021VAERSVAX
1289785	05/05/2021	WI	16.0	16		F		Patient was given vaccine under the approve age range. No adverse events noted.										04/30/2021	04/30/2021	0		PVT							2	05/05/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1292623	05/06/2021	WI	16.0	16		F		PATIENT GOT THE MODERNA COVID 19 VACCINE, SHE IS 16 YEARS OLD									N	04/05/2021	04/05/2021	0		PHM							2	05/06/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1297976	05/07/2021	WI	16.0	16		F		4 hours later after My daughter got 2nd COVID vaccine Small round red rashes on the face .									U	05/07/2021	05/07/2021	0		PUB		None	None	None			2	05/07/2021				None	2021VAERSSYMPTOMS	2021VAERSVAX
1301259	05/09/2021	WI	16.0	16		M		Patient fainted in store about 5 minutes after receiving vaccination, patient seemed anxious when vaccine was given									Y	04/15/2021	04/15/2021	0	Blood pressure was normal after incident	PHM							2	05/09/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1302993	05/10/2021	WI	16.0	16		M		Moderna administered under 18 year old									Y	05/03/2021	05/03/2021	0		PHM							2	05/10/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1307886	05/11/2021	WI	16.0	16		M		Initial complaint: feeling lightheaded, couldn't see, diaphoretic, pale 12:10 BP 60 systolic HR 64 Patient diaphoretic, "can't see". Ice pack, granola bar and water provided. 12:15 BP 56 systolic Second ice pack provided. Reports "feel better"									U	05/06/2021	05/06/2021	0		PUB		None	None reported	None known			2	05/11/2021				NKDA	2021VAERSSYMPTOMS	2021VAERSVAX
1307924	05/11/2021	WI	16.0	16		M		HPI: Patient is a 16-year-old male who was upgraded to our emergency department after blood work showed a significant thrombocytopenia. Please see walk-in clinic provider NP for presenting history and physical exam. Patient reports to me development of									U	04/29/2021	05/10/2021	11	Diagnostics: Results for orders placed or performed during the hospital encounter of 05/10/21 CBC WITH DIFFERENTIAL Result Value Ref Range White Blood Cells 7.72 4.0 - 13.0 K/uL Red Blood Cells 3.48 (L) 4.15 - 5.30 M/uL Hemoglobin 10.8 (L) 11.8 - 15.	PVT		This is your record. Keep this with you and show to your community pharmacist(s) and physician(s) at each visit. Allergies: No Known Allergies Medications Valid as of: May 11, 2021 - 4:41 PM Generic Name Brand Name Tablet Size Instruct	4/16/21 ED visit N/V/D diagnosed with viral gastroenteritis COVID-19 antigen negative 4/25/21 ED visit fever, sore throat, earache, dizziness, shortness of breath. Rapid strep negative, COVID-19 antigen and Influenza negative diagnosised with otitis media				2	05/11/2021		Y		None	2021VAERSSYMPTOMS	2021VAERSVAX
1310244	05/12/2021	WI	16.0	16		M		On 5/6/2021 Presented to urgent care. Clinically Dx with Herpes Zoster. PCR testing for Varicella pending.									U	04/29/2021	05/06/2021	7	Varicella PCR pending	PHM		Allegra Sudafed	Runny nose the week of 4/29/21	None			2	05/12/2021		Y		Environmental	2021VAERSSYMPTOMS	2021VAERSVAX
1311457	05/12/2021	WI	16.0	16		M		16 year old vaccinated with Moderna										04/09/2021	04/09/2021	0		PUB							2	05/12/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1314023	05/13/2021	WI	16.0	16		F		PATIENT LOST CONSCIOUSNESS, FELL FORWARD OUT OF CHAIR (WAS CAUGHT AND ASSISTED TO THE FLOOR), PATIENT REGAINED CONSCIOUSNESS, EMERGENCY SERVICES WERE CALLED, PULSE, BLOOD SUGAR, OXYGEN, AND VISION WERE FINE, PATIENT VERY LIGHT HEADED, BLOOD PRESSURE EXTREM									Y	05/08/2021	05/08/2021	0	EKG PERFORMED BY PARAMEDIC'S IN AMBULANCE, AND A SECOND PERFORMED BY URGENT CARE	PHM		N/A	N/A	N/A			2	05/13/2021			Y	N/A	2021VAERSSYMPTOMS	2021VAERSVAX
1315645	05/13/2021	WI	16.0	16		M		Constant stomach pain , and vomiting - symptoms occurred 24 hours after injection of 1st vaccine shot.					Y	4			Y	04/24/2021	04/25/2021	1	Child taken to his pediatrician?s office on 04/27/2021 and examined. Diagnosed with possible inflamed appendix and urged to go to emergency room immediately. Appendix was removed on 04/27/2021 and patient was hospitalized until 04/30/2021 for recovery a	PVT		None	None	None			2	05/13/2021				None	2021VAERSSYMPTOMS	2021VAERSVAX
1323819	05/17/2021	WI	16.0	16		M		16 year old received dose of Moderna instead of Pfizer, which is indicated for age less than 18. No adverse effects, informed patient, patient's mother. Consulted pediatrician and family medicine physician for recommendations. Per conversations with all p									Y	05/12/2021	05/12/2021	0	n/a	PHM							2	05/17/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1336945	05/21/2021	WI	16.0	16		M		It was discovered after the patient left that the patient received a full vial of undiluted vaccine (6 doses). Our organization contacted Pfizer, CDC, Poison Control and the Hospital Infectious Disease for recommendations on next steps. The patient was not									U	05/20/2021	05/20/2021	0	none that we are aware of	PVT							2	05/21/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1337571	05/21/2021	WI	16.0	16		F		Covid vaccine administered on 5/20. 1704 - in observation room pt complained of feeling warm and a sore throat. 1706 - 50 mg Benadryl PO given, VS HR 93, POX 99, BP 128/68 1710 - VS HR 97, POX 98 1712 - pt states throat feels better. 1715 - pt st										05/20/2021	05/20/2021	0		PVT							2	05/21/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1352742	05/26/2021	WI	16.0	16		M		Presented as a pulled muscle in the left chest/lung area. No SOB, just pain and tightness in the chest. Began after the second vaccine and occurred on and off for about 2-3 weeks.									U	04/26/2021	04/27/2021	1	None to date.	PUB		None	None	None			2	05/26/2021				PCN	2021VAERSSYMPTOMS	2021VAERSVAX
1374753	06/04/2021	WI	16.0	16		M		After vaccination upon documenting, it was realized that vaccine was given 14 days from 1st dose, rather than 221 days.									Y	06/03/2021	06/03/2021	0	none	PVT		none	None	None			2	06/04/2021				None	2021VAERSSYMPTOMS	2021VAERSVAX
1381735	06/08/2021	WI	16.0	16		F		Breakthrough infection										05/16/2021	05/31/2021	15		UNK							2	06/08/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1385333	06/09/2021	WI	16.0	16		M		Patient was under 18 year old, and received Moderna									Y	02/25/2021	02/25/2021	0		PHM							2	06/09/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1388381	06/10/2021	WI	16.0	16		F		Mom stated that patient reported she did not feel well about 6:30 pm (the same evening). She then sat down, eyes rolled back in her head, speech was slurred and finally, became unresponsive for about 10 seconds. She was sweating uncontrollably, had a tempe									Y	06/09/2021	06/09/2021	0	None	PUB		N/A	No	N/A-Recently diagnosed with scoliosis			2	06/10/2021				Allergy to Amoxicillin-rash	2021VAERSSYMPTOMS	2021VAERSVAX
1391842	06/11/2021	WI	16.0	16		M		No adverse event. Vaccine was given to a minor. J&J vaccine has not yet been approved for minors. Error was realized after event happened. Parent still signed consent, in addition to EAU given that stated must be 18yrs or older and signs posted. Health Dep									U	04/01/2021	04/01/2021	0	n/a	PUB		n/a	n/a	n/a			2	06/11/2021				n/a	2021VAERSSYMPTOMS	2021VAERSVAX
1395034	06/13/2021	WI	16.0	16		M		Under age vaccination									Y	04/30/2021	04/30/2021	0		PHM							2	06/13/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1397018	06/14/2021	WI	16.0	16		F		vomiting for 4 days, head ache, hot flashes, loss of appetite, thirsty, achy, eye twitches									N	06/09/2021	06/09/2021	0		PHM		D3, birth control,inhaler		asthema,			2	06/14/2021				unknown	2021VAERSSYMPTOMS	2021VAERSVAX
1403434	06/16/2021	WI	16.0	16		F		After receiving first COVID vaccine, patient walked out of the immunization room and up towards the photo department where she reported tunnel vision then fainted into her mother's arms. Patient instantaneously recovered and sat on the floor. Technician wa									Y	06/16/2021	06/16/2021	0		PHM							2	06/16/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1410735	06/18/2021	WI	16.0	16		M		CLIENT WAS 16 YRS AT DATE OF VACCINE AND WAS SPANISH PEAKING ONLY									U	06/17/2021	06/17/2021	0	NONE	PUB		NONE	NONE	NONE			2	06/18/2021				NONE	2021VAERSSYMPTOMS	2021VAERSVAX
1411041	06/18/2021	WI	16.0	16		F		Chest pain, upset stomach, elevated heart rate and blood pressure Performed tests, gave them water and advised to drink electrolyte rich fluids and take Tylenol or Ibuprofen every 6 hours for discomfort.									Y	05/28/2021	05/28/2021	0	X-ray chest single view: lungs are clear, heart size normal, no pleural effusion or pneumothorax, no acute osseous abnormality. Magnesium: 2.0 mg/dL, TSH Reflex Free T4: 2.44, Troponin <0.01, CBC with Differential all within normal parameters except Absolu	OTH		American Health Chewable Super Papaya Enzyme Plus		Stomach upset			2	06/18/2021		Y	Y	Azythromycin and Augmentin - rash, difficulty breathing	2021VAERSSYMPTOMS	2021VAERSVAX
1417097	06/22/2021	WI	16.0	16		F		Patient under age of 18 and received Moderna.										06/08/2021				PUB							2	06/22/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1437461	06/30/2021	WI	16.0	16		M		Onset of hives the morning following vaccine. Continued at the time of this report. Taking Benadryl per Dr. Will update with symptoms as needed									N	06/28/2021	06/29/2021	1		PVT							2	06/30/2021				None	2021VAERSSYMPTOMS	2021VAERSVAX
1437583	06/30/2021	WI	16.0	16		M		When asked, patient states he did not eat or drink anything today. He noticed a tiny spot of blood at injection site, while his band-aid was being applied, he asked "Is this bad?". Shortly after after her complained of not feeling well. He complained of ha									Y	06/30/2021	06/30/2021	0	N/A	PUB		N/A	N/A	N/A			2	06/30/2021				N/A	2021VAERSSYMPTOMS	2021VAERSVAX
1437793	06/30/2021	WI	16.0	16		F		Community event attended by staff offering Moderna and Janssen COVID vaccines to public. Client filled out consent and listed DOB. Client signed consent. Fact sheet offered, screening questions discusses with RN prior to vaccination. Client verbalized and									U	06/27/2021	06/27/2021	0		PUB							2	06/30/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1443640	07/02/2021	WI	16.0	16		M		Janssen vaccine administered to patient under the age of 18. No adverse reactions reported.										04/08/2021	04/08/2021	0		PHM							2	07/02/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1461655	07/09/2021	WI	16.0	16		M		Initial needle puncture made in error with syringe with no contents - air, gas, liquid or otherwise. Syringe plunger was depressed without any movement of plunger. Administration error noted by Vaccinator post attempted vaccination and subsequently repor										07/09/2021	07/09/2021	0		PVT							2	07/09/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1468371	07/14/2021	WI	16.0	16		F		While completing paperwork in immunization room, patient's mother stated she thought her daughter was starting to react to the vaccine. It appeared patient was starting to pass out so pharmacist and mother lowered her down from the chair to the floor to pr									Y	07/13/2021	07/13/2021	0	None	PHM		None per patient's mother	None per patient's mother	None per patient's mother			2	07/14/2021				None per patient's mother	2021VAERSSYMPTOMS	2021VAERSVAX
1478208	07/16/2021	WI	16.0	16		F		Left VM to return call. No return contact made. no report of adverse reaction.										05/27/2021				PUB		None listed	none reported	None reported			2	07/16/2021				None listed	2021VAERSSYMPTOMS	2021VAERSVAX
1478503	07/16/2021	WI	16.0	16		F		Sore throat, nasal congestion, cough, headache, body aches 24 hours after vaccine.									N	07/10/2021	07/11/2021	1	strep test neg. No covid swab done. Day #6, no covid contacts or travel.	PVT		no	none	none			2	07/16/2021				none	2021VAERSSYMPTOMS	2021VAERSVAX
1486072	07/20/2021	WI	16.0	16		M		Leg weakness, heaviness. which appeared the next day in the evening after vaccination									U	07/14/2021	07/15/2021	1	CBC, CMP, CK 7-16-21 Low platelets 108,000 Slightly elevated LFTs AST/SGOT 14 - 35 U/L 64High ; ALT/SGPT 0 - 55 U/L 124High Normal CK	PVT		Ibuprofen, Vitamin D and Zicam	Low grade fever 100.5 and headache	None			2	07/20/2021		Y		None	2021VAERSSYMPTOMS	2021VAERSVAX
1502216	07/26/2021	WI	16.0	16		M		(mother positive first), Sx onset 7/18/21 cough, runny nose, chills, headache, muscle aches, loss of smell & loss of taste.									Y	05/18/2021	07/18/2021	61	Specimen Collection Date: 7/24/2021 Specimen Source: nasopharyngeal swab Test Performed: SARS CoV-2 RNA, TMA / SARS Cornavirus-2 RNA, V Result: DETECTED	PVT							2	07/26/2021		Y			2021VAERSSYMPTOMS	2021VAERSVAX
1502222	07/26/2021	WI	16.0	16		M		(mother positive first), Sx onset 7/18/21 cough, runny nose, chills, headache, muscle aches, loss of smell & loss of taste.									Y	06/08/2021	07/18/2021	40	Specimen Collection Date: 7/24/2021 Specimen Source: nasopharyngeal swab Test Performed: SARS CoV-2 RNA, TMA / SARS Cornavirus-2 RNA, V Result: DETECTED	PVT							2	07/26/2021		Y			2021VAERSSYMPTOMS	2021VAERSVAX
1512812	07/29/2021	WI	16.0	16		F		Patient 16 years of age. Moderna vaccine for those 18 years and older. Too young to receive the Moderna vaccine.									Y	07/22/2021	07/22/2021	0		PUB							2	07/29/2021				None	2021VAERSSYMPTOMS	2021VAERSVAX
1517866	07/31/2021	WI	16.0	16		M		administered liquid portion only / not reconstituted with lyophilized portion.; administered liquid portion only / not reconstituted with lyophilized portion.; This case was reported by a nurse via call center representative and described the occurrence of									U	06/30/2021	06/30/2021	0		UNK						USGLAXOSMITHKLINEUS202116	2	07/30/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1518413	07/31/2021	WI	16.0	16		M		Patient was given first COVID19 vaccine at around 1800 with no obvious signs or symptoms. Patients mother explained the history of fainting after vaccinations with pharmacist, when around 1810 patient started feeling dizzy and fainted. Patient was able to									Y	07/30/2021	07/30/2021	0	none	PHM		none	none that were documented on the VAR	none	Flu vaccine - 2020 - fainting		2	07/31/2021				none	2021VAERSSYMPTOMS	2021VAERSVAX
1519454	08/02/2021	WI	16.0	16		M		The first few days, patient had exhaustion and arm pain, which was expected...it seemed to be subsiding a bit, but then Thursday morning he was hit with a wave of fatigue again. He then had severe nausea, was freezing cold, and vertigo. I took his temperat									U	07/26/2021	07/29/2021	3		PVT			none	asthma, gluten intolerance			2	08/02/2021				gluten	2021VAERSSYMPTOMS	2021VAERSVAX
1523185	08/03/2021	WI	16.0	16		F		No adverse event. Patient received one dose of vaccine prior to age 18.									Y	06/17/2021	06/17/2021	0	N/A	SEN		unknown	unkknown	unknown			2	08/03/2021				NKDA	2021VAERSSYMPTOMS	2021VAERSVAX
1531563	08/06/2021	WI	16.0	16		F		Patient went to urgent Care with pain at injection site, pain radiating down through right leg and up through the right side of her neck									U	08/05/2021	08/05/2021	0		PVT		Choline Dihydrogen Citrate 300mg BID Cymbalta 30mg qday Lactobacillus Acidophilus 1 tab qday Anaprox 440mg BID Progesterone 100mg qday		Migraines POTS Exercised induced asthma Generalized Anxiety Disorder			2	08/06/2021			Y	Gluten Dairy	2021VAERSSYMPTOMS	2021VAERSVAX
1531750	08/06/2021	WI	16.0	16		M		Patient is an otherwise healthy 16-year-old male who is presenting to the emergency department concerns for SVT. Patient states that he was sitting at home and went to go stand up when he suddenly felt uncomfortable feeling in his chest as well as some li									U	05/17/2021	05/18/2021	1		UNK							2	08/06/2021			Y		2021VAERSSYMPTOMS	2021VAERSVAX
1531812	08/06/2021	WI	16.0	16		M		Chest pain that came and went not related to breathing									Y	06/07/2021	07/01/2021	24	EKG	UNK		Multivitamin	Cold	Asthma			2	08/06/2021		Y	Y	Sulfa, amoxicillin, Ceftinor	2021VAERSSYMPTOMS	2021VAERSVAX
1531859	08/06/2021	WI	16.0	16		M		PATIENT DID NOT MEET AGE REQUIREMENT TO RECEIVE MODERNA VACCINE. WHEN PATIENT PRESENTED FOR DOSE TWO OF COVID VACCINE SERIES, THE PATIENT RECEIVED APPROPRIATE BRAND BASED ON AGE (PFIZER LOT#EWO162). NO ADVERSE REACTIONS OR SIDE EFFECTS REPORTED BY PATIENT										03/15/2021	03/15/2021	0	NONE	PHM		N/A	N/A	N/A			2	08/06/2021				N/A	2021VAERSSYMPTOMS	2021VAERSVAX
1532007	08/06/2021	WI	16.0	16		M		16 year old male who presents with sudden onset chest pain. Patient states that he woke up with sudden chest pain at about 3:30 a.m. this morning and later fell asleep again as the pain was better. Around 9:30 AM he had worsening chest pain with some rad					Y	3			U	07/06/2021	07/09/2021	3		PVT							2	08/06/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1534766	08/07/2021	WI	16.0	16		F		7/26/2021 had insanely heavy menstrual cycle that was soaking pads within an hour (normal is ~4-5 hours). She had cramps that she has never experienced before 7/26 eve and 7/27 daytime. There were large blood clots present (>> quarter size) 7/26-7/28. No									U	04/28/2021	07/26/2021	89	n/a	PVT		Meningitis vacc on 6/4/2021 hycosamine	IBS	IBS	at 9 y.o. chicken pox vacc: pneumonia and cellulitis	?	2	08/07/2021				gluten sensitive	2021VAERSSYMPTOMS	2021VAERSVAX
1545033	08/11/2021	WI	16.0	16		F		Vaccine given under the age of 18. No Medical adverse events. Vaccination error.									U	03/16/2021	03/16/2021	0	N/A	OTH		N/A	N/A	N/A			2	08/11/2021				N/A	2021VAERSSYMPTOMS	2021VAERSVAX
1600106	08/21/2021	WI	16.0	16		F		Moderna COVID 19 vaccine given to 16 year old; This spontaneous case was reported by a nurse and describes the occurrence of PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (Moderna COVID 19 vaccine given to 16 year old) in a 16-year-old female patien									Y	03/29/2021	03/29/2021	0		UNK						USMODERNATX, INC.MOD20210	2	08/12/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1628585	08/24/2021	WI	16.0	16		M		HISTORY OF PRESENT ILLNESS: Patient is a 16-year 4-month-old previously well male admitted to the ICU from the emergency room at Hospital where he presented with a 1 day history of chest pain. 3 days prior to admission Patient had his second Pfizer Covid					Y	3				08/17/2021	08/18/2021	1		UNK							2	08/24/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1666960	09/02/2021	WI	16.0	16		F		After mixing vile, and administering two 0.3ml doses there was not enough vaccine left in the vile to administer anymore doses.									U	09/02/2021	09/02/2021	0	Pfizer company contacted on 9-2-21. They said there is no specific information or side effects to this at this time. Proceed with next dose of 0.3ml	WRK				Congenital insufficiency of aortic valve, prolonged QT interval, aortic valve regurgitation, VSD (ventricular septal defect), Orthostatic proteinuria, heavy menstrual bleeding, iron deficiency, ADHD, generalized anxiety disorder, depression, migraine with			2	09/02/2021				effexor, azithromycin dihydrate	2021VAERSSYMPTOMS	2021VAERSVAX
1670671	09/03/2021	WI	16.0	16		M		Second dose of Pfizer-BioNTech vaccine administered. Patient became slightly aloof as his mom noticed a change in his facial expression and a slight disconnected look in his eyes. Mom asked if patient was ok, to which he stated "yes" and attempted to stand									U	08/27/2021	08/27/2021	0	Unsure. Mom signed release form and patient did not leave with paramedics.	PHM		NiA	N/A	N/A			2	09/03/2021				N/A	2021VAERSSYMPTOMS	2021VAERSVAX
1675150	09/05/2021	WI	16.0	16		F		Approximately 10 minutes after receiving her first COVID vaccine the patient's father asked the pharmacist to help his daughter as she stated she wasn't feeling well. Upon examining the patient, the patient looked as though she was having a possible seizur									Y	09/03/2021	09/03/2021	0		PHM		None listed on profile	None identified or reported	None reported			2	09/05/2021			Y	None listed on profile	2021VAERSSYMPTOMS	2021VAERSVAX
1679373	09/07/2021	WI	16.0	16		F		None, was just underage									Y	08/03/2021	08/03/2021	0	None	PHM		None	No illness	None			2	09/07/2021				None	2021VAERSSYMPTOMS	2021VAERSVAX
1683143	09/08/2021	WI	16.0	16		M		No adverse reaction									Y	08/30/2021	08/30/2021	0	the Pfizer vaccine in the refrigerator has a longer shelf life, it's more than 31 days. called Pfizer company to ask if the vaccine is viable.	PVT		no	no	no			2	09/08/2021				none	2021VAERSSYMPTOMS	2021VAERSVAX
1692834	09/11/2021	WI	16.0	16		M		expired MENACTRA was given to a patient with no adverse event; Initial information regarding an unsolicited valid non-serious case was received from other health care professional and non-health care professional/consumer via Medical Information (Reference									U	08/30/2021	08/30/2021	0		UNK						USSA2021SA293543	2	09/07/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1694568	09/13/2021	WI	16.0	16		F		pulmonary embolism	Y	03/30/2021							N	03/19/2021	03/28/2021	9	autopsy	OTH		albuterol, Flovent, doxycycline, drospirenone and ethinyl estradiol, and Zoloft		asthma			2	09/13/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1708705	09/17/2021	WI	16.0	16		M		Patient received J&J vaccine and at the time was 16 years old. Vaccine is approved for 18 and older.									Y	09/15/2021	09/15/2021	0		PHM							2	09/17/2021		Y			2021VAERSSYMPTOMS	2021VAERSVAX
1715679	09/20/2021	WI	16.0	16		M		Not age approved for Moderna emergency use vaccine. Patient is 16 years of age									Y	09/06/2021	09/06/2021	0	None	OTH		none	none	none			2	09/20/2021				none	2021VAERSSYMPTOMS	2021VAERSVAX
1715840	09/20/2021	WI	16.0	16		M		Administration to unauthorized age group. Accidental/unintentional administration. 5 days muscle aches, headaches, subjective fever, hot flashes, nausea with emesis x 1.										09/15/2021	09/20/2021	5	None	PHM		None	Asthma, eczema.	Congenital anomalous right coronary artery origin.			2	09/20/2021		Y		Cats, dogs, dust	2021VAERSSYMPTOMS	2021VAERSVAX
1759169	10/04/2021	WI	16.0	16		F		Child was 16 years old at the time of vaccination.										02/09/2021	02/09/2021	0		PUB							2	10/04/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1813246	10/23/2021	WI	16.0	16		F		8/13/2021- Date of 1st vaccination patient was already on menstrual cycle-no abnormal issues (heavy bleeding) during the 1st dose. Issues (heavy bleeding) noticed on or during 2nd dose, during menstrual. 9/3/2021- Date of 2nd vaccination; patient had her			Y		Y	1			U	08/08/2021	09/04/2021	27		PVT		None	None	None			2	10/23/2021		Y		No known allergies	2021VAERSSYMPTOMS	2021VAERSVAX
1815025	10/25/2021	WI	16.0	16		F		Patient contracted COVID after being fully vaccinated Congestion, Body aches, headache, chills										04/21/2021	10/23/2021	185		PHM		Albuterol q4hr prn for wheezing cetirizine 10mg daily prn for allergy symptoms Ortho Tri-Cyclene Lo Daily Fluoxetine 30mg daily fluticasone BID Fluticasone nasal Daily melatonin 2.5mg HS Multivitamin daily	4/2021 - Dysuria	Asthma Anxiety and Depression			2	10/25/2021				Omnicef Omni-Pac - Hives Zithromax - unknown	2021VAERSSYMPTOMS	2021VAERSVAX
1815412	10/25/2021	WI	16.0	16		F		BREAKTHROUGH COVID INFECTION, MILD SX									N	05/12/2021	10/24/2021	165	POS COVID-19/ABBOTT	PVT		NONE	NONE	NONE			2	10/25/2021		Y		NONE	2021VAERSSYMPTOMS	2021VAERSVAX
1817175	10/26/2021	WI	16.0	16		F		received a dose which expired; This case was reported by a other health professional via call center representative and described the occurrence of expired vaccine used in a 16-year-old female patient who received HBV (Engerix B) (batch number YL2L3, expir									U	10/20/2021	10/20/2021	0		UNK						USGLAXOSMITHKLINEUS202121	2	10/25/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1839648	11/03/2021	WI	16.0	16		M		Provider history and physical 10/20/21: "PT is a 16 y.o. male patient without a significant past medical history who presents with shock in the setting of fevers, vomiting, and diarrhea. Symptoms began on 10/17 with fever, body aches and headaches. Feve					Y	7			Y	04/30/2021	10/17/2021	170	Hospital Course-unable to inlcude results from entire hospitalization "CNS: Remained at baseline through admission, no issues with pain. Patient noticed blurry vision after given IV steroids that improved throughout his stay. Discussed with ophthalmology	UNK		None	None documented	None			2	11/03/2021		Y	Y	Dust mites Pollen	2021VAERSSYMPTOMS	2021VAERSVAX
1846792	11/05/2021	WI	16.0	16		F		The patient was given booster dose of Pfizer COVID-19 vaccine.									U	11/05/2021	11/05/2021	0	None	PUB		Unknown	Unknown				2	11/05/2021				Unknown	2021VAERSSYMPTOMS	2021VAERSVAX
1854668	11/09/2021	WI	16.0	16		F		Was very tired and had sore muscles on September 09. Found September 10, 5:25 am dead. There were excessive amounts of blood along with large blood clots that appear to have come vaginally.	Y	09/10/2021							N	09/07/2021	09/01/2021		There was no autopsy ordered	PVT		omeprazole gabapentin celecoxib nivolumab was last given on 9/03/2021	Squamous cell lung cancer, Hx of radiation therapy, on antineoplastic chemotherapy, Esophagitis due to radiation,	Recurrent respiratory papillomatosis, Tracheal papillomatosis			2	11/09/2021				Pineapple	2021VAERSSYMPTOMS	2021VAERSVAX