|
| VAERS ID: |
903022 (history) |
| Form: |
Version 2.0 |
| Age: |
47.0 |
| Sex: |
Female |
| Location: |
New York |
| 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: Headache,
Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (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: No labs done
CDC Split Type: vsafe
Write-up: Caller stated at 11:30 a.m caller had right arm pain at injection site and headache. 12/17/20 headache and arm paid has subsided. |
|
| VAERS ID: |
903023 (history) |
| Form: |
Version 2.0 |
| Age: |
35.0 |
| Sex: |
Female |
| Location: |
Puerto Rico |
| 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 |
EH 9899 / 1 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Myalgia,
Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No
Current Illness: COVID-19 on November 11, 2020
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: None
CDC Split Type:
Write-up: Fever (37.8 ?C) and muscle pain. |
|
| VAERS ID: |
903024 (history) |
| Form: |
Version 2.0 |
| Age: |
43.0 |
| Sex: |
Female |
| Location: |
Puerto Rico |
| 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: Eye pain,
Headache,
Rosacea
SMQs:, Glaucoma (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: Aspirin
Diagnostic Lab Data: N/A
CDC Split Type:
Write-up: Headache, right retroocular pain, exacerbation of rosacea Tx. acetaminophen Duration: 3 hours |
|
| VAERS ID: |
903028 (history) |
| Form: |
Version 2.0 |
| Age: |
47.0 |
| Sex: |
Female |
| Location: |
Texas |
| 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 |
PAA156051 / 1 |
LA / IM |
Administered by: Work Purchased by: ?
Symptoms: Arthralgia,
Fatigue,
Nausea,
Pruritus
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (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: Tylenol 2 500mg (before vaccination);
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type: vsafe
Write-up: 12/15/2020 Around 7:30pm, I started to itch on neck and face. Progressed to scalp, stomach, back and whole body; ears, top of head to bottom of toes. Called critical care healthcare staff; 1 25mg benadryl Had nausea, fatigue, hip and joint pain 12/16/2020 Still itchy not as severe as 12/15/2020. Still joint pain and achiness. Nausea was a 8/10. 12/17/2020 feel better. About 80% . Mild itchiness. ''letting it run its course'' and haven''t taken any other benadryl since 12/15/2020. Joint and nausea has subsided. Flu shot 09/2020 Second dose of Pfizer shot is scheduled for 01/05/2021 |
|
| VAERS ID: |
903030 (history) |
| Form: |
Version 2.0 |
| Age: |
54.0 |
| Sex: |
Female |
| Location: |
D.C. |
| 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: Private Purchased by: ?
Symptoms: Chest pain,
Dizziness,
Dysgeusia,
Dysphagia,
Dyspnoea,
Electrocardiogram normal,
Flushing,
Immediate post-injection reaction,
Pallor,
Paraesthesia,
Tremor
SMQs:, Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), 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: Candesartan
Current Illness:
Preexisting Conditions: Hypertension.
Allergies: Seasonal allergies (spring-summer)
Diagnostic Lab Data: Normal EKG
CDC Split Type:
Write-up: ~30 minutes after vaccination, patient reported lightheadedness, difficulty swallowing, SOB, feeling flushed, pallor, bilateral arm tingling, brief chest pain and tremors. Symptoms lasted approximately 30 minutes and then resolved. Benadryl given after resolution of acute symptoms. Reported a metallic taste in her mouth immediately after receiving the COVID vaccine (dose #1). Had uneventful 15 minute recovery period immediately after vaccination. |
|
| VAERS ID: |
903031 (history) |
| Form: |
Version 2.0 |
| Age: |
29.0 |
| 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 |
- / UNK |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Chills,
Headache,
Injected limb mobility decreased,
Myalgia,
Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (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: Insulin
Current Illness: No
Preexisting Conditions: Diabetic
Allergies: No
Diagnostic Lab Data: No
CDC Split Type: vsafe
Write-up: 2 hours later pain in arm approximately 4-5 inches. Was not able to utilize left arm on yesterday. last night experienced muscle aches and chills. Taken Tylenol and rested. This morning experienced a really bad headache. |
|
| VAERS ID: |
903034 (history) |
| Form: |
Version 2.0 |
| Age: |
68.0 |
| Sex: |
Male |
| Location: |
Texas |
| 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: Dizziness,
Vertigo
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Individual received vaccine on 12/17/20 at 0815. Began with feeling faint and "spinning" at approx. 11:00 am, reported resolution of symptoms at approx. 11:11 am on 12/17/20. |
|
| VAERS ID: |
903035 (history) |
| Form: |
Version 2.0 |
| Age: |
75.0 |
| Sex: |
Female |
| Location: |
Iowa |
| 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 |
EK5700 / 1 |
LA / SYR |
Administered by: Private Purchased by: ?
Symptoms: Flushing,
Pruritus,
Rash,
Rash erythematous
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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Corlanor 5mg, twice a day, Potassium 20 meq per day, HCTZ daily,
Current Illness: Renal Tubular Acidosis type 1.
Preexisting Conditions: Renal Tubular Acidosis Type 1 Hypocalemia Pacemaker
Allergies: Lidocaine (includes all caines), Contrast Dye
Diagnostic Lab Data: None
CDC Split Type:
Write-up: Stayed for 15 minutes after the vaccine given and no reaction was noted and she left. States she got into her car about 20 minutes after the vaccine and started to "itch" all over and noted "red bumps" on the back of her neck. She had a flushed face by the time she arrived home but remained afebrile. Her itchiness is better but only concentrated on the back of her neck on 12/17/20 when she reported the reaction to Employee Health Services. She denied any further issues today. |
|
| VAERS ID: |
903036 (history) |
| Form: |
Version 2.0 |
| Age: |
42.0 |
| 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 |
- / UNK |
LA / IM |
Administered by: Unknown Purchased by: ?
Symptoms: Back pain,
Headache,
Nausea,
Pain in extremity
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: Ibuprofen
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: No
CDC Split Type: vsafe
Write-up: I have a sore arm and I am experiencing severe back pain, nausea and a headache that comes and goes. |
|
| VAERS ID: |
903040 (history) |
| Form: |
Version 2.0 |
| Age: |
26.0 |
| Sex: |
Female |
| Location: |
Puerto Rico |
| 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: Chills,
Injection site erythema,
Injection site pain,
Limb discomfort,
Mobility decreased,
Nausea,
Pain,
Skin warm
SMQs:, Acute pancreatitis (broad), Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: B3, Biotin
Current Illness: None
Preexisting Conditions: None
Allergies: aspirin and any product derived from it
Diagnostic Lab Data: None
CDC Split Type: vsafe
Write-up: arm felt hot to the touch, felt arm heavy very difficult to move the arm, felt feverish, took temperature but no fever, but hot to the touch, lots of chills, nausea, body aches. Took some tylenol and at night it started getting a little better. This morning the injection site is red and is sore but I can move my arm again. |
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