|
| VAERS ID: |
903217 (history) |
| Form: |
Version 2.0 |
| Age: |
30.0 |
| 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 |
EK5730 / UNK |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Dizziness,
Headache,
Increased upper airway secretion
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Spironolactone 50 mg bid, vitamin d 2000iu
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa
Diagnostic Lab Data:
CDC Split Type:
Write-up: COVID vaccine administered to patient. She began to have lightheadedness and dizziness. She disclosed she had not yet eaten for the day, except for a glass of milk. Writer brought her to an exam table and had her lay down. After 5-10 minutes, she was given a banana and two small apple juice boxes. She then laid back down. After another 5 minutes, she complained of headache and slight phlegm development in her throat. Dr. was called to evaluate- after an assessment, she asked for a BP. Writer completed the vitals and found her BP was 113/77. 5 more minutes passed. Dr. advised that since her situation was not improving and headache and phlegm appeared to be getting worse, patient should receive epi and go to the hospital. Writer administered 0.3mg/0.3mL of epi and drove patient to the Emergency Department of Hospital. She was there for about two hours before being discharged. Symptoms largely resolved by the evening. |
|
| VAERS ID: |
903218 (history) |
| Form: |
Version 2.0 |
| Age: |
54.0 |
| Sex: |
Male |
| Location: |
Mississippi |
| 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: Asthenia,
Chest discomfort,
Electrocardiogram,
Laboratory test,
Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol taken after vaccination
Current Illness:
Preexisting Conditions: Diabetes
Allergies: None
Diagnostic Lab Data: EKG and labs completed
CDC Split Type:
Write-up: Patient reports chest heaviness, muscle aches, loss of energy. No fever or chills noted. |
|
| VAERS ID: |
903220 (history) |
| Form: |
Version 2.0 |
| Age: |
46.0 |
| Sex: |
Female |
| Location: |
Montana |
| 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 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Injection site pain,
Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (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: Bupoprion 150mg 1daily , Escitalopriam 5mg 1daily, Clonazapam 0.5mg 1daily
Current Illness: None
Preexisting Conditions: None
Allergies: Coconut
Diagnostic Lab Data:
CDC Split Type: vsafe
Write-up: Pain in right arm , Pain in shot site |
|
| VAERS ID: |
903221 (history) |
| Form: |
Version 2.0 |
| Age: |
47.0 |
| Sex: |
Female |
| Location: |
Arizona |
| 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 |
EK 5730 / 1 |
UN / IM |
Administered by: Private Purchased by: ?
Symptoms: Blood pressure increased,
Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypertension (narrow), Cardiomyopathy (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: Unknown
Current Illness: No
Preexisting Conditions: NIDDM (Type 2)
Allergies: No
Diagnostic Lab Data: None
CDC Split Type:
Write-up: Patient with tachycardia and elevated BP about 20 min following vaccination; O2 sat okay; sat down for 15 min and symptoms resolved without treatment |
|
| VAERS ID: |
903222 (history) |
| Form: |
Version 2.0 |
| Age: |
37.0 |
| Sex: |
Female |
| Location: |
Colorado |
| 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 |
EJ1685 / 1 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Headache,
Injection site pain,
Product preparation issue
SMQs:, Extravasation events (injections, infusions and implants) (broad), Medication errors (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:
Current Illness:
Preexisting Conditions:
Allergies: No Known Allergies
Diagnostic Lab Data:
CDC Split Type:
Write-up: Patient is suspected to have received 0.3mL of undiluted vaccine (150mcg vs 30mcg). Patient reported having a dull headache 3/10 pain scale since yesterday afternoon post vaccination. Patient also reported soreness in her right arm down to her elbow. She did not experience any other symptoms. |
|
| VAERS ID: |
903223 (history) |
| Form: |
Version 2.0 |
| Age: |
25.0 |
| Sex: |
Female |
| Location: |
Maine |
| 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 / SYR |
Administered by: Private Purchased by: ?
Symptoms: Chills,
Fatigue,
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: None
Current Illness: None
Preexisting Conditions: None
Allergies: penicillin
Diagnostic Lab Data: None
CDC Split Type: vsafe
Write-up: 12/16 It''s hard to know because I have a fever but I work on the COVID unit and there has been an outbreak, chills, fatigue, and the thought of moving to take a shower I feel in pain |
|
| VAERS ID: |
903224 (history) |
| Form: |
Version 2.0 |
| Age: |
57.0 |
| Sex: |
Female |
| Location: |
Alaska |
| 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: Private Purchased by: ?
Symptoms: Flushing,
Heart rate increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypersensitivity (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: unknown
Current Illness: none
Preexisting Conditions: obesity, cardiac disease with internal monitor/defibrillator
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:
Write-up: Heart rate increase, flushed for about 20 minutes. She has an internal monitor/defibrillator. States "it feels like when they do a dvice check." |
|
| VAERS ID: |
903225 (history) |
| Form: |
Version 2.0 |
| Age: |
58.0 |
| Sex: |
Female |
| Location: |
Kansas |
| 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: Private Purchased by: ?
Symptoms: Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (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: unknown
Current Illness: no
Preexisting Conditions: unknown
Allergies: allergic to Keflex (difficulty breathing)
Diagnostic Lab Data: none
CDC Split Type:
Write-up: about 15 minutes after shot, pt had itching. After another 15 minutes the itching resolved and patient left facility |
|
| VAERS ID: |
903226 (history) |
| Form: |
Version 2.0 |
| Age: |
50.0 |
| Sex: |
Female |
| Location: |
Texas |
| 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 / SYR |
Administered by: Private Purchased by: ?
Symptoms: Injection site pain,
Pain
SMQs:, Extravasation events (injections, infusions and implants) (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: Minocyclin, Mirena IUD, Divigel estrogen cream
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: None
CDC Split Type: vsafe
Write-up: 12/16/2020 Pain in the left deltoid uncomfortable to elevate and abduct my arm, it feels better today but it hurt yesterday to even elevate my arm to the steering wheel of my car |
|
| VAERS ID: |
903227 (history) |
| Form: |
Version 2.0 |
| Age: |
52.0 |
| Sex: |
Female |
| Location: |
Hawaii |
| 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 |
RA / IM |
Administered by: Military Purchased by: ?
Symptoms: Hypoaesthesia,
Hypoaesthesia oral,
Nausea
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: Erythromycin and Ciprofloxacin
Diagnostic Lab Data: none
CDC Split Type:
Write-up: Pfizer-BioNTech COVID-19 Vaccine EUA within the first hour of dose, facial numbness on right side of face that migrated to lips. Within 2 hours of dose, nausea. |
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