|
| VAERS ID: |
903008 (history) |
| Form: |
Version 2.0 |
| Age: |
25.0 |
| Sex: |
Female |
| Location: |
Michigan |
| 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 |
- / UNK |
LA / IM |
Administered by: Unknown 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: No
Current Illness: No
Preexisting Conditions: No
Allergies: I''m allergic to glutten, shrimp and dairy
Diagnostic Lab Data: No
CDC Split Type: vsafe
Write-up: I had a headache, body aches and fatigue. |
|
| VAERS ID: |
903009 (history) |
| Form: |
Version 2.0 |
| Age: |
|
| Sex: |
Female |
| 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 |
- / 1 |
RA / IM |
Administered by: Work Purchased by: ?
Symptoms: Blood glucose normal,
Chills,
Cold sweat,
Confusional state,
Dizziness,
Nausea,
Visual impairment
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (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: Heart arrhythmia medication.
Current Illness: no
Preexisting Conditions: Heart arrhythmia
Allergies: kna
Diagnostic Lab Data: Pulse ox : 97 blood sugar tested 90 after orange juice. BP130/80 p 127
CDC Split Type:
Write-up: Patient complained of vision disturbance confusion dizziness, chills, clammy, no trouble breathing. Nausea, Patient stated she did not have any breakfast. gave patient diphenhydramine 25 mg and EMS arrived to take her to the hospital. |
|
| VAERS ID: |
903010 (history) |
| Form: |
Version 2.0 |
| Age: |
|
| 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 |
- / 1 |
LA / IM |
Administered by: Work Purchased by: ?
Symptoms: Confusional state,
Slow response to stimuli,
Visual impairment
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (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: yes.
Current Illness: UTI
Preexisting Conditions: yes
Allergies: kna
Diagnostic Lab Data: Pulse ox 100 no sob bp 125/67 Pulse 58
CDC Split Type:
Write-up: After receiving vaccine patient started complain of vision disturbance, confusion, nurses started he was slow to respond. Nurses also documented that he was acting the same way the day before due to UTI. No SOB . no signs of allergic reaction |
|
| VAERS ID: |
903011 (history) |
| Form: |
Version 2.0 |
| Age: |
68.0 |
| 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 / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: started feeling nauseated, had her sit until feelings resolved. |
|
| VAERS ID: |
903014 (history) |
| Form: |
Version 2.0 |
| Age: |
86.0 |
| Sex: |
Male |
| Location: |
West Virginia |
| 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 |
RA / IM |
Administered by: Senior Living Purchased by: ?
Symptoms: Computerised tomogram normal,
Confusional state,
Dyspnoea,
Haematuria,
Laboratory test normal,
Loss of consciousness,
Neurological examination normal,
Syncope,
Tonic clonic movements,
Unresponsive to stimuli,
Urinary assistance device user,
Urinary tract infection
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Finasteride 5mg qd, Terazosin 10mg qd, pantoprazole 40mg qd, memantine er 7mg qd, tramadol 50mg q8PRN, Xarelto 15mg BID, Aricept 5mg qd, synthroid 100mcg qd, mirtazapine 15mg qhs, centrum silver qd, calcium + vitamin D BID, melatonin 3mg qh
Current Illness: Patient has recurrent DVTs. Patient had ORIF (held Xarelto for a week prior to procedure) and then patient had pneumonia and DVT with PE prior to admission at Nursing Facility on December 10, 2020. UTI diagnosed after transport to hospital on December 16, 2020.
Preexisting Conditions: Patient has recurrent DVTs. Alzheimer''s (nutritional deficiencies secondary to this diagnosis as well), urinary retention, hypertension, anemia, hypothyroidism, BPH, insomnia.
Allergies: No known allergies
Diagnostic Lab Data: Patient had a CT scan, which came back normal. He was diagnosed with a UTI and administered Ceftriaxone at the hospital and discharged back to Nursing Home on Omnicef the same day.
CDC Split Type:
Write-up: Patient reported to CNA that they felt like they soiled their pants. CNA confirmed that patient did not soil themself and transferred patient to the restroom. While the patient was on the toilet attempting to have a bowel movement the CNA reported patient had 10 seconds of tonic clonic behavior and then went unresponsive and then back to tonic clonic behavior. This happened 3 times prior to getting patient put back into his bed. Patient went unconscious after last episode while on bed for a more extended period of time while a STAT page was called. Physical Therapist and Aid sternal rubbed him and he had gasp and woke up. Prior to and immediately following the episode his vitals were within normal limits. Neuro exam was unremarkable after patient came to. When he woke up he knew his name, date, and day of the week. He was only confused to where he was. Patient was agreeable to be transported out. EMS was called and transported the patient to Hospital. Patient displayed no seizure activity or neurological deficits in ER. Patient had a CT scan, which came back normal. Virals remained within normal limits and laboratory values were noncontributory. He was diagnosed with a UTI due to the presence of hematuria associated with a syncopal episode. Patient had a Foley catheter upon admission to the nursing home. Patient was administered Ceftriaxone at the hospital and discharged back to Nursing Home on Omnicef the same day. Patient is back at nursing home facility and has not displayed any additional signs of seizure. He is stable and Foley catheter has been removed. Facility spoke to wife who reported that patient did not have a seizure history. |
|
| VAERS ID: |
903015 (history) |
| Form: |
Version 2.0 |
| Age: |
52.0 |
| Sex: |
Male |
| Location: |
Kansas |
| 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 |
EH9899 / 2 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Diarrhoea,
Fatigue,
Injection site reaction,
Migraine,
Muscle fatigue
SMQs:, Rhabdomyolysis/myopathy (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (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: Pneumonia vaccine
Other Medications: Vitamin D Multivitamin, Men''s Health, Centrum
Current Illness: No
Preexisting Conditions: Swelling to legs, chronic Was diabetic until one year ago
Allergies: Bleach
Diagnostic Lab Data: no
CDC Split Type:
Write-up: Fatigue, migraine, muscle fatigue on site, diarrhea. |
|
| VAERS ID: |
903016 (history) |
| Form: |
Version 2.0 |
| Age: |
54.0 |
| 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 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Anaphylactic reaction,
Chest X-ray,
Dyspnoea,
Flushing,
Hypoaesthesia,
Laboratory test,
Panic attack,
Paraesthesia,
Respiratory rate increased,
Tremor
SMQs:, Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Hypoglycaemia (broad), Sexual dysfunction (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: migraine, obstructive sleep apnea
Allergies: clindamycin, clotrimazole, dihydroergotamine, IV contrast medium, prochlorperazine, promethazine, sumatriptan
Diagnostic Lab Data:
CDC Split Type:
Write-up: Approximately 11 minutes after receiving the vaccine, the patient complained of shortness of breath, tingling in arms and hands, numbness and tingling in legs and feet, and was observably shaking, with no complaints of swelling in throat or other signs of anaphylaxis. Patient was brought to ER in same facility via stretcher and was examined by staff there. ER report states the patient presented with shortness of breath and what appeared to be a panic attack, with fast breathing, slight flushing, and shaking. Per ER report, the patient was treated for an acute anaphylactic reaction, with clear lungs and given an EpiPen shot in the right thigh. IV was initiated and given a fluid bolus, solu medrol, famotidine, and lorazepam. Labs and a chest x-ray done and reviewed. After treatment, patient found to be stable and was discharged home at 4:42 pm with orders for famotidine, albuterol inhaler, and epinephrine pen. |
|
| VAERS ID: |
903017 (history) |
| Form: |
Version 2.0 |
| Age: |
47.0 |
| Sex: |
Female |
| Location: |
Kansas |
| 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 |
EH9899 / 1 |
OT / OT |
Administered by: Public Purchased by: ?
Symptoms: Syringe issue
SMQs:, Medication errors (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: The nurse was tapping the syringe to get all the air out and the needle popped out of the vaccine vial and stuck to the sticker that was on the vial. 0.3ml of the vaccine was discarded with the syringe into the sharps box. |
|
| VAERS ID: |
903018 (history) |
| Form: |
Version 2.0 |
| Age: |
49.0 |
| 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: Public Purchased by: ?
Symptoms: Arthralgia,
Fatigue,
Feeling of body temperature change,
Headache,
Myalgia,
Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), 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: Daily multi vitamin, Probiotic
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data:
CDC Split Type: vsafe
Write-up: I woke up at 6:15am had a terrible headache, low fever 100.1. I took Tylenol for the headache and fever. Throughout the day exp muscle aches and joint pain. I also exp hot/cold flashes and fatigue. Around 6:00pm on 12/16 started to l feel better and was able to return to work on 12/17. |
|
| VAERS ID: |
903019 (history) |
| Form: |
Version 2.0 |
| Age: |
50.0 |
| Sex: |
Female |
| Location: |
Connecticut |
| 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 |
- / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Headache,
Lymphadenopathy,
Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Digoxin, metformin, metropolol, propafenone, baclofen, rosuvastin, gabapentin, doloxetine
Current Illness: None
Preexisting Conditions: Diabetic, wolf parkinsons wide syndrome, Spinal cord decompression surgery, suffered nerve damage
Allergies: iodine, seafood, bee stings
Diagnostic Lab Data: None
CDC Split Type: vsafe
Write-up: I took tylenol for fever and headache and rested, left side lymph nodes were swollen on 12/16/20 which was the worst day, and has gotten better today 12/17/2020. Did not go to the doctor. |
|
