|
| VAERS ID: |
902945 (history) |
| Form: |
Version 2.0 |
| Age: |
38.0 |
| Sex: |
Male |
| Location: |
Idaho |
| Vaccinated: | 2020-12-17 |
| Onset: | 2020-12-17 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EH9899 / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Immediate post-injection reaction,
Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: immediate burning upon injection, VS stable |
|
| VAERS ID: |
902946 (history) |
| Form: |
Version 2.0 |
| Age: |
26.0 |
| Sex: |
Male |
| Location: |
West Virginia |
| Vaccinated: | 2020-12-17 |
| Onset: | 2020-12-17 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EH9899 / 1 |
RA / IM |
Administered by: Public Purchased by: ?
Symptoms: Angioedema,
Peripheral swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? Yes
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: No
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa (oral)
Diagnostic Lab Data: na
CDC Split Type:
Write-up: Swelling of hands follwed by angioedema |
|
| VAERS ID: |
902948 (history) |
| Form: |
Version 2.0 |
| Age: |
44.0 |
| Sex: |
Male |
| Location: |
Oklahoma |
| Vaccinated: | 2020-12-15 |
| Onset: | 2020-12-15 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EK5730 / 1 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Rash pustular
SMQs:, 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: Metformin 500mg bid Irbesartan 150mg qd Depo-testosterone 200mg IM 2qwks
Current Illness: None
Preexisting Conditions: Diabetes mellitus, type 2 Hypertension
Allergies: Tramadol
Diagnostic Lab Data: none
CDC Split Type:
Write-up: Papular, pustular rash on back occurring approximately 6-10 hours after injection of vaccine. |
|
| VAERS ID: |
902949 (history) |
| Form: |
Version 2.0 |
| Age: |
33.0 |
| Sex: |
Male |
| Location: |
North Dakota |
| Vaccinated: | 2020-12-17 |
| Onset: | 2020-12-17 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EH9899 / 1 |
RA / SYR |
Administered by: Private Purchased by: ?
Symptoms: Pharyngeal paraesthesia
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre 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: None
Current Illness: None
Preexisting Conditions: Congenital One Kidney
Allergies: Cat Dander - Reaction of Rash, Itchy Eyes
Diagnostic Lab Data:
CDC Split Type:
Write-up: While waiting the 15 minute after vaccination the Patient noticed a "tingling" feeling in throat about 5 minutes after vaccine was given. Time: 0930 - Oxygen Saturation was 98% Pulse Rate 100. Patient stated that the feeling went away and then came back. Time: 0938 - Again vital signs were taken BP 156/88 Oxygen Saturation 100% Pulse Rate 83. Time: 0942 - 50 mg of Benadryl PO were given with water at this time. Patient was taken to ER for evaluation. |
|
| VAERS ID: |
902952 (history) |
| Form: |
Version 2.0 |
| Age: |
44.0 |
| Sex: |
Male |
| Location: |
Oklahoma |
| Vaccinated: | 2020-12-15 |
| Onset: | 2020-12-15 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EK5730 / 1 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Chills,
Dizziness,
Headache
SMQs:, Anticholinergic syndrome (broad), 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:
Current Illness: None
Preexisting Conditions: Diabetes mellitus, type 2 Hypertension
Allergies: No known allergies
Diagnostic Lab Data: none
CDC Split Type:
Write-up: Dizziness, headache, chills |
|
| VAERS ID: |
902983 (history) |
| Form: |
Version 2.0 |
| Age: |
26.0 |
| Sex: |
Female |
| Location: |
California |
| Vaccinated: | 2020-12-16 |
| Onset: | 2020-12-16 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Chills,
Fatigue,
Headache,
Injection site pain,
Myalgia,
Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 2000 IU Vitamin D q day
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:
Write-up: Pfizer-BioNTech COVID-19 Vaccine EUA. Injection site pain, headache, tiredness, muscle pain, chills and fever. Took acetaminophen, no longer have fever after 12 hrs. |
|
| VAERS ID: |
902984 (history) |
| Form: |
Version 2.0 |
| Age: |
23.0 |
| Sex: |
Female |
| Location: |
Illinois |
| Vaccinated: | 2020-12-17 |
| Onset: | 2020-12-17 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EK5730 / UNK |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Chest pain
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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: Patient stated she started to feel a burning sensation in her chest about 7 minutes after receiving injection. Lasted about 5 minutes, then left. |
|
| VAERS ID: |
902987 (history) |
| Form: |
Version 2.0 |
| Age: |
44.0 |
| Sex: |
Male |
| Location: |
Kentucky |
| Vaccinated: | 2020-12-16 |
| Onset: | 2020-12-16 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EK5730 / 1 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Incorrect dose administered,
Injection site pain,
Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad), 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: None requested. APRN followed up with patient 12/17/2020 11:0 0AM EST. The patient only has arm pain, no other side effects noted. The patient has been taking ibuprofen for injection site pain.
CDC Split Type:
Write-up: Medication error - reached the patient no harm, additional monitoring to preclude harm. A nurse (RN) diluted new vial of vaccine at 10:41 am. In the midst of adding diluent to vaccine vial, a patient arrived at our vaccine station. After drawing up and administering the 0.3 ml vaccine the RN looked at the vial again and noted that it was almost empty. She became concerned because she had just mixed a new vial and the amount of fluid remaining was not at the expected level. We immediately stopped and reported this to an employee who contacted pharmacy. We notified the patient that there was a discrepancy and had him wait for $g 30 minutes to watch for any reaction. (APRN) called him at 1:30p to check on him and apprise him of the possibility of receiving higher than recommended concentration of vaccine. He stated he felt fine and felt no unusual symptoms. |
|
| VAERS ID: |
902988 (history) |
| Form: |
Version 2.0 |
| Age: |
61.0 |
| Sex: |
Female |
| Location: |
North Carolina |
| Vaccinated: | 2020-12-16 |
| Onset: | 2020-12-16 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / UNK |
LA / IM |
Administered by: Unknown Purchased by: ?
Symptoms: Fatigue
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: Vitamin D , Multi vitamin, fish oil, calcium
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: No
CDC Split Type: vsafe
Write-up: I was tired and took a two hour nap |
|
| VAERS ID: |
902989 (history) |
| Form: |
Version 2.0 |
| Age: |
33.0 |
| Sex: |
Female |
| Location: |
Nebraska |
| Vaccinated: | 2020-12-15 |
| Onset: | 2020-12-16 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EH9899 / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Body temperature increased,
Fatigue,
Headache
SMQs:, Neuroleptic malignant syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, Norethindrone, prenatal vitamin
Current Illness: None
Preexisting Conditions: Hypothyroidism
Allergies: Penicillins
Diagnostic Lab Data: none
CDC Split Type:
Write-up: Headache, fatigue, temperature of 100.3. Lasted about 8 hours. |
|
