|
| VAERS ID: |
902990 (history) |
| Form: |
Version 2.0 |
| Age: |
30.0 |
| Sex: |
Female |
| Location: |
Arkansas |
| 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: Anosmia,
Asthenia,
Chills,
Cough,
Influenza virus test,
Pain,
Pyrexia,
SARS-CoV-2 test,
Streptococcus test
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (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: lexapro.
Current Illness: Taking antibiotics for bladder infeciton at time of vaccination
Preexisting Conditions: none
Allergies: Amoxicillin
Diagnostic Lab Data: Swabbed for Covid, FLu, and Strep at Employee Health Clinic
CDC Split Type:
Write-up: fever, cough,chills,body aches, weakness, loss of smell |
|
| VAERS ID: |
902991 (history) |
| Form: |
Version 2.0 |
| Age: |
37.0 |
| Sex: |
Female |
| Location: |
Ohio |
| 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 |
UN / IM |
Administered by: Private Purchased by: ?
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Augmentin - Sweilling
Diagnostic Lab Data: N/A
CDC Split Type:
Write-up: rash - treatment: acetaminophen and diphenhydramine |
|
| VAERS ID: |
902992 (history) |
| Form: |
Version 2.0 |
| Age: |
30.0 |
| Sex: |
Female |
| Location: |
New Mexico |
| 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: Fatigue,
Headache,
Pain
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: Sertraline
Current Illness: None
Preexisting Conditions: PCOS
Allergies: Latex
Diagnostic Lab Data:
CDC Split Type:
Write-up: fatigue, soreness, headache occurred the night after receiving vaccine ( approx. 8 hours later) lasting into the following day. I did not take any medications for this . |
|
| VAERS ID: |
902995 (history) |
| Form: |
Version 2.0 |
| Age: |
37.0 |
| 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 |
EK5730 / 1 |
LA / IM |
Administered by: Military Purchased by: ?
Symptoms: Chest X-ray normal,
Chest discomfort,
Chest pain,
Chills,
Computerised tomogram normal,
Nausea,
Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: pt developed chills, nausea and vomiting. Reports $g 10 episodes of vomiting total. Went to lunch and continued to have chills and vomiting. Also developed chest pain - described as burning and heaviness. Denies any shortness of breath. CT negative for any changes. Chest X ray normal. |
|
| VAERS ID: |
902997 (history) |
| Form: |
Version 2.0 |
| Age: |
30.0 |
| Sex: |
Male |
| Location: |
Kansas |
| Vaccinated: | 2020-12-16 |
| Onset: | 2020-12-17 |
| 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 |
EK5730 / 1 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Dizziness,
Glassy eyes,
Hyperhidrosis,
Nausea,
Visual tracking test abnormal
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PANTOPRAZOLE
Current Illness: NONE
Preexisting Conditions: ASTHMA
Allergies: PENICILLIN
Diagnostic Lab Data:
CDC Split Type:
Write-up: SWEATY, NAUSEA, DIZZY, EYES GLAZED OVER, NOT TRACKING RIGHT, STARTED MORNING AFTER SHOT |
|
| VAERS ID: |
902998 (history) |
| Form: |
Version 2.0 |
| Age: |
59.0 |
| Sex: |
Female |
| Location: |
Montana |
| 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: Arthralgia,
Chills,
Decreased appetite,
Fatigue,
Headache,
Myalgia,
Nausea,
Pain in extremity,
Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:
Write-up: Morning after injection: mild fatigue, arm soreness; later in the morning-headache then chills, muscle aches, joint pain and low grade fever (99) and nausea/loss of appetite. These persisted for approximately 12 hours then cleared completely. |
|
| VAERS ID: |
903001 (history) |
| Form: |
Version 2.0 |
| Age: |
62.0 |
| Sex: |
Male |
| Location: |
Delaware |
| 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: Work Purchased by: ?
Symptoms: Abdominal pain,
Bowel movement irregularity,
Chills,
Defaecation urgency,
Exercise tolerance decreased,
Fatigue
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (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: Alopine 10mg 1xday, Lotharton 100mg 1x/day
Current Illness: N/A
Preexisting Conditions: Hypertension
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type: vsafe
Write-up: 12/15/2020 615 received vaccine 2pm belly pains, relief ''not like normal bowel movement'', ''urge to go'' 5 belly pain, relief self''not like normal bowel movement'', ''urge to go'' 8-10 pm body chills, covered with 3+ blankets 10 pm body chills subsided 12/16/2020 fatigue; not exercise; 5miles per day (only able to walk 2 miles) Flu vaccine; ''pretty sure it was 09/2020''; Unknown brand |
|
| VAERS ID: |
903002 (history) |
| Form: |
Version 2.0 |
| Age: |
45.0 |
| Sex: |
Female |
| Location: |
Unknown |
| 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: Anxiety,
Blood pressure increased,
Chest discomfort,
Paraesthesia,
Pharyngeal paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypertension (narrow), Cardiomyopathy (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Patient received the vaccine. During the 15 minute observation period she developed chest heaviness, arm tingling, and throat tingling. BP elevated at 169/79. The patient was sent to the ED and evaluated. Diagnosed with more anxiety type symptoms. Discharge from ED stable. |
|
| VAERS ID: |
903004 (history) |
| Form: |
Version 2.0 |
| Age: |
29.0 |
| Sex: |
Male |
| Location: |
New Hampshire |
| 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: Work Purchased by: ?
Symptoms: Blood pressure increased,
Chest discomfort,
Chest pain,
Dizziness,
Feeling hot,
Hyperhidrosis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydroxyzine, omeprazole
Current Illness: no
Preexisting Conditions: Sleep apnea, GERD
Allergies: amoxicillin, questioning rather I am allergic to latex, it has not been confirmed.
Diagnostic Lab Data: Workup was completed in ER.
CDC Split Type: vsafe
Write-up: 17 minutes after vaccine, suddenly had a , crushing squeezing chest pain, very severe lasted 45 seconds. after 45 seconds continue to have moderate chest pain, light headiness, diaphoretic, very hot. NO fever, elevated BP. Mild to moderate chest and light headiness for about 3-4 hours and it self solved. |
|
| VAERS ID: |
903007 (history) |
| Form: |
Version 2.0 |
| Age: |
57.0 |
| Sex: |
Female |
| Location: |
Alabama |
| 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: Contraindicated product administered
SMQs:, Medication errors (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient had a shingles vaccine 12/10/2020.
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: None.
CDC Split Type:
Write-up: She had received a shingles vaccine on 12/10/2020. |
|
