|
| VAERS ID: |
903082 (history) |
| Form: |
Version 2.0 |
| Age: |
66.0 |
| Sex: |
Male |
| Location: |
Missouri |
| 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 |
UNKNOWN / UNK |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Cough,
Diarrhoea,
Dyspnoea,
Hyperhidrosis,
Mental status changes,
Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Yes
Current Illness: none, did have covid by pcr in November, no one asked that question.
Preexisting Conditions: HTN, PTSD, hypercholesterolemia
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:
Write-up: Persistant cough, dyspnea, sweats, myalgias, mental staus changes and diarrhea, still resoving |
|
| VAERS ID: |
903085 (history) |
| Form: |
Version 2.0 |
| Age: |
44.0 |
| Sex: |
Female |
| Location: |
Missouri |
| 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 |
RA / IM |
Administered by: Work Purchased by: ?
Symptoms: Ear pruritus,
Eye swelling,
Feeling hot,
Ocular discomfort,
Paraesthesia
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Guillain-Barre syndrome (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:
Current Illness:
Preexisting Conditions:
Allergies: Codeine, Ciprofloxacin, Flagyl
Diagnostic Lab Data:
CDC Split Type:
Write-up: 1145: Patient complained of minor left eye swelling. Vital signs 99%, 83, 141/80. 1155: Vitals rechecked 1155 100%, 79, 112/80. Patient has new complaints of itchy ears, facial "heat", and slight tingling in fingers. 1200: 25 mg of oral Benadryl given. 1211: per RN, patient states symptoms are resolving. 1230: Patient still feels slight eye discomfort, all other symptoms have resolved. Patient states she feels comfortable leaving vaccination clinic, her son will be taking her home. |
|
| VAERS ID: |
903089 (history) |
| Form: |
Version 2.0 |
| Age: |
40.0 |
| 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 |
EH9899 / 1 |
LA / IM |
Administered by: Unknown Purchased by: ?
Symptoms: Chills,
Dizziness,
Fatigue,
Flank pain,
Headache,
Myalgia,
Neck pain,
Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Eosinophilic pneumonia (broad), Vestibular disorders (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? No
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:
CDC Split Type:
Write-up: Headache , dizziness, neck pain, left flank pain, fever 100.2 , chills,fatigue and muscle aches. |
|
| VAERS ID: |
903091 (history) |
| Form: |
Version 2.0 |
| Age: |
57.0 |
| 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 |
EJ1685 / 1 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Arthralgia,
Fatigue,
Headache,
Injection site pain,
Injection site swelling,
Injection site warmth,
Limb discomfort,
Pain in extremity,
Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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: Sometimes with the FLU vaccination would feel tired.
Other Medications: Thyroid,Vitamin D, Allergy, Multi Vitamin
Current Illness: No
Preexisting Conditions: No
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type: vsafe
Write-up: I noticed the injection site was sore, swollen and warm. As the day progressed headache, fatigue, joint, legs aching and feeling heavy tires. Also had a fever of 101.2.Around 9:30 pm on 12/16 started to feel better fever was down. |
|
| VAERS ID: |
903092 (history) |
| Form: |
Version 2.0 |
| Age: |
25.0 |
| 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 |
- / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Fatigue,
Headache,
Lymphadenopathy,
Pain,
Pain in extremity,
Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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: Flu shot I got sick once when I was a kid, I usually just get a sore arm
Other Medications: 20mg lisinopril, 40mg protonic, Birth control pill, Claritin, Valtrex 500mg
Current Illness: None
Preexisting Conditions: High blood pressure, acid reflux
Allergies: None
Diagnostic Lab Data: None
CDC Split Type: vsafe
Write-up: 12/15/2020My arm was really sore at first, and then my arm was worse the next day on 12/16/2020 as the morning went on my temperature felt like it was going up and down I felt body aches and felt really tired I had covid in June and it wasn''t as bad as when I had it in June but it was still pretty bad, I also had a headache, I took tylenol and my fever broke but after a few hours my headache was worse and I started to take tylenol and ibuprofen. 12/17/2020 Under my left arm my lymph nodes are swollen but I feel much better and will go to work today 12/17/2020 |
|
| VAERS ID: |
903094 (history) |
| Form: |
Version 2.0 |
| Age: |
38.0 |
| Sex: |
Female |
| Location: |
Wisconsin |
| 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,
Dizziness,
Fatigue,
Feeling cold,
Heart rate increased,
Hypertension,
Incoherent,
Tinnitus
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hypertension (narrow), Hearing impairment (narrow), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (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: Vitamin D3, C, Zinc
Current Illness: Had COVID in the beginning of 11/2020. (Tested on 11/03 results came on 4th - positive)
Preexisting Conditions: None
Allergies: Penicillin
Diagnostic Lab Data: None
CDC Split Type: vsafe
Write-up: 40 min after shot experienced dizziness, feeling like was going to pass out, not coherent, BP high, fast heart rate, light headed. Got chills, freezing cold, shivering, and later in the day my ears were ringing. Extremely fatigued. |
|
| VAERS ID: |
903095 (history) |
| Form: |
Version 2.0 |
| Age: |
52.0 |
| Sex: |
Female |
| Location: |
Oklahoma |
| 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: Blood pressure increased,
Chest discomfort,
Dizziness,
Heart rate increased,
Hyperhidrosis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (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: Gabapentin, escitalopram, hydroxychloroquine, Breo Ellipta, Singulair, Celebrex, Lyrica
Current Illness:
Preexisting Conditions: Asthma Rheumatoid arthritis
Allergies: Sulfa allergy
Diagnostic Lab Data:
CDC Split Type:
Write-up: Approximately 10 minutes after receiving the vaccine in the left arm, the patient began feeling lightheaded and had some chest heaviness. They became diaphoretic and at this point blood pressure and heart rate were checked. HR was elevated to 90 bpm from patient''s baseline of approximately 60-65 bpm. Blood pressure was elevated at 150/100 mmHg. Pt was provided water and symptoms resolved. Patient was monitored an additional 30 minutes and did not have any recurrence of symptoms. Blood pressure and heart rate returned to baseline. |
|
| VAERS ID: |
903112 (history) |
| Form: |
Version 2.0 |
| Age: |
44.0 |
| Sex: |
Female |
| Location: |
Arkansas |
| 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: Work Purchased by: ?
Symptoms: Electrocardiogram abnormal,
Flushing,
Heart rate irregular,
Palpitations,
Ventricular extrasystoles
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypersensitivity (broad), Hypokalaemia (broad), Noninfectious myocarditis/pericarditis (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: solifenacin, fluticasone, loratadine
Current Illness:
Preexisting Conditions:
Allergies: codeine
Diagnostic Lab Data:
CDC Split Type:
Write-up: Patient felt flushed, heart racing. Had irregular rhythm. Transported to Emergency Department. Treated with epinephrine. EKG performed, having pre-ventricular contractions. Checked in to ED for further evaluation. |
|
| VAERS ID: |
903115 (history) |
| Form: |
Version 2.0 |
| Age: |
35.0 |
| Sex: |
Female |
| Location: |
Virginia |
| 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 |
LA / IM |
Administered by: Unknown Purchased by: ?
Symptoms: Chills,
Pain,
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: Paxil 40 mg qd Ambien 10 mg qhs prn
Current Illness: Cold
Preexisting Conditions: Anxiety
Allergies: None
Diagnostic Lab Data:
CDC Split Type:
Write-up: Fever, severe body aches, severe chills, still have symptoms this morning although less severe. |
|
| VAERS ID: |
903118 (history) |
| Form: |
Version 2.0 |
| Age: |
39.0 |
| Sex: |
Female |
| Location: |
North Carolina |
| 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 |
LA / IM |
Administered by: Work Purchased by: ?
Symptoms: Headache,
Injection site rash,
Nausea,
Rash,
Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: gastric by-pass
Allergies: azithromycin, pepcid
Diagnostic Lab Data:
CDC Split Type:
Write-up: Patient came to workplace clinic 12/17 @ 1215 saying she had a reaction to the COVID vaccination. She stated she took ibuprofen in the morning for the headache, however, rash was still present. N/V on 12/16 at night. Patient reported no throat swelling or SOB. Rash on injection site (left) arm and chest. Patient received Benadryl 50 mg po x 1 dose and Tylenol 500 mg po x 1 dose. After Benadryl and Tylenol, patient felt better and was able to go back to work. recommended to go home and rest. |
|
