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. |