|
| VAERS ID: |
902493 (history) |
| Form: |
Version 2.0 |
| Age: |
24.0 |
| Sex: |
Male |
| Location: |
South Dakota |
| Vaccinated: | 2020-12-15 |
| Onset: | 2020-12-15 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-15 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EH9899 / 1 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Dizziness,
Flushing
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (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: At 12:55 pm 10 minutes following vaccine being given states feeling lightheaded and flush. Was sitting in the chair. Encouraged him to lay down on the floor which he did on his own. Feet elevated. BP 174/70 pulse 82. Denies any other complaints. Laid on floor for 15 minutes then sat in chair. Denies complaints. 1:15 pm was allowed to leave. BP 120/80 and states feeling fine. |
|
| VAERS ID: |
902505 (history) |
| Form: |
Version 2.0 |
| Age: |
39.0 |
| Sex: |
Female |
| Location: |
Kansas |
| Vaccinated: | 2020-12-15 |
| Onset: | 2020-12-15 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-15 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
GH9899 / 1 |
RA / IM |
Administered by: Work Purchased by: ?
Symptoms: Blood pressure increased,
Ear discomfort,
Flushing,
Palpitations,
Paraesthesia,
Skin warm
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Hypertension (narrow), Cardiomyopathy (broad), Hypersensitivity (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Patient felt facial flushing, pounding in chest, burning and hot ears and blood pressure went up. Tingly in right arm and chest and hands. Symptoms resolved, after a few minutes but then returned. Patient sat with nurse during this reaction. |
|
| VAERS ID: |
902508 (history) |
| Form: |
Version 2.0 |
| Age: |
30.0 |
| Sex: |
Female |
| Location: |
New Jersey |
| Vaccinated: | 2020-12-15 |
| Onset: | 2020-12-15 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-15 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EH9899 / 1 |
LA / SYR |
Administered by: Other Purchased by: ?
Symptoms: Paraesthesia oral,
Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (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: unknown
Preexisting Conditions: unknown
Allergies: cucumbers
Diagnostic Lab Data: None
CDC Split Type:
Write-up: She claims she experienced tightness in the right side of throat and her tongue started tingling. Took her the Emergency Department, She decided to go and buy Benadryl |
|
| VAERS ID: |
902514 (history) |
| Form: |
Version 2.0 |
| Age: |
25.0 |
| Sex: |
Female |
| Location: |
Texas |
| Vaccinated: | 2020-12-15 |
| Onset: | 2020-12-15 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-15 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EK5730 / 1 |
RA / IM |
Administered by: Work Purchased by: ?
Symptoms: Inappropriate schedule of product administration
SMQs:, Medication errors (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: N/A
Current Illness: N/A
Preexisting Conditions: none documented
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:
Write-up: System was not populating immunization record, member denied having immunizations within last 14 days. Vaccine given, record populated and patient had anthrax on 12/10/20 |
|
| VAERS ID: |
902518 (history) |
| Form: |
Version 2.0 |
| Age: |
58.0 |
| Sex: |
Female |
| Location: |
Indiana |
| Vaccinated: | 2020-12-15 |
| Onset: | 2020-12-15 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-15 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EJ1685 / 1 |
AR / IM |
Administered by: Private Purchased by: ?
Symptoms: Eye pruritus,
Feeling hot,
Paraesthesia,
Paraesthesia oral
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre 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: Latex, Norflex, shellfish, pomegranate, almond, bees
Diagnostic Lab Data:
CDC Split Type:
Write-up: Tingling of upper lip and cheeks, warmth in face, and itchy eyes Treatment: diphenhydramine 50 mg PO x1 Outcome: symptom onset within 15 minutes of vaccine administration. Symptoms resolved within 20-30 minutes of diphenhydramine administration. |
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| VAERS ID: |
902524 (history) |
| Form: |
Version 2.0 |
| Age: |
59.0 |
| Sex: |
Female |
| Location: |
Nebraska |
| Vaccinated: | 2020-12-15 |
| Onset: | 2020-12-15 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-15 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EJ685 / 1 |
LA / IM |
Administered by: Public Purchased by: ?
Symptoms: Asthenia,
Fatigue,
Feeling abnormal,
Heart rate increased,
Hypertension,
Impaired driving ability,
Limb discomfort,
Nervousness
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Guillain-Barre syndrome (broad), Hypertension (narrow), 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: Dorzolamide HCL/Timolol Maleate Ophthalmic Solution BID Sodium Chloride Ophthalmic Solution BID (10 min before other eye drops) and PRN Muro 128 (Sodium Chloride Hypertonicity Ophthalmic Ointment) @ Bedtime Prenatal Multivitamin (for
Current Illness: none
Preexisting Conditions: borderline diabetic
Allergies: Allergies: Morphine Spinal and Lumigan (Bimatoprost oph. sol.)
Diagnostic Lab Data: none
CDC Split Type:
Write-up: I am a immunization nurse at this location. I gave 2 of the first 4 Covid vaccinations given at our location. Then I received dose # 5. It was easy. I did a couple of things and then returned to my desk. As I sat down, my arm started feeling very heavy. I was unable to send a text. I told staff that I was feeling funny and that I was going to the other room to lay down. Staff followed me and took my Pulse 100 and BP 164/ 82 (high for me!) . I felt shaky, but my hands were not shaking. Put a wet cloth on my head and laid there a few minutes, telling staff stories and laughing at my BP. When I sat up, my BP was 126/74 and pulse was 80. I stood up for a minute or two, then my legs got heavy and I sat down for a few more minutes. I went to the bathroom and came back to my desk, but was weak and tired. I ate and drank some fluids. Because it was snowing and I live 25 miles away, I accepted a ride home from a co-worker. I walked across the parking lot without problems and talked all the way home. At home, I was tired, but had a sandwich and talked on the phone. I would still describe myself as tired, but functioning. |
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| VAERS ID: |
902557 (history) |
| Form: |
Version 2.0 |
| Age: |
32.0 |
| Sex: |
Female |
| Location: |
Alaska |
| Vaccinated: | 2020-12-15 |
| Onset: | 2020-12-15 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-15 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EK5730 / 1 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Blood glucose normal,
Blood test,
Dyspnoea,
Erythema,
Flushing,
Hyperhidrosis,
Pulse abnormal,
Tunnel vision
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Retinal disorders (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Nuvaring
Current Illness: none
Preexisting Conditions: low blood sugar, low blood pressure
Allergies: None
Diagnostic Lab Data: ED visit, blood draw, monitoring - 12/15/20
CDC Split Type:
Write-up: 1750- IM injection ot R Deltoid. She was sitting, and felt short of breath without wheeze or tightness in the chest or throat. She stood up, and then felt tunneling. Assisted to chair and floor. Pulse weak, skin flushed, sweating on torso. Face and Neck remained flushed and red. She refused epi at first. So we gave her benedryll 25 mg po with apple juice. She said she just had a big meal 30 min prior, but we checked her blood sugar- it was 85. 10 min after the first SOB feeling, it returned. BP was recorded as 160/100. |
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| VAERS ID: |
902572 (history) |
| Form: |
Version 2.0 |
| Age: |
24.0 |
| Sex: |
Female |
| Location: |
Texas |
| Vaccinated: | 2020-12-15 |
| Onset: | 2020-12-16 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-16 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EH9899 / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Chills,
Nausea,
Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Mirena IUD
Current Illness: N/A
Preexisting Conditions: Iron deficiency anemia
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:
Write-up: Pfizer-BioNTech COVID-19 Vaccine EUA Developed chills, nausea and vomiting beginning at 2 AM the night after receiving the vaccine. Potential fever as well (I don''t have a thermometer to check). Symptoms have lasted over 3 hours thus far, still continuing. |
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| VAERS ID: |
902575 (history) |
| Form: |
Version 2.0 |
| Age: |
55.0 |
| Sex: |
Male |
| Location: |
Florida |
| Vaccinated: | 2020-12-15 |
| Onset: | 2020-12-16 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-16 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
RA / IM |
Administered by: Unknown 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:
Current Illness:
Preexisting Conditions:
Allergies: Iodine
Diagnostic Lab Data: None
CDC Split Type:
Write-up: Pain in deltoid muscle upon pressure at night. Hard to lay on the side of the vaccine due to pain in the arm |
|
| VAERS ID: |
902576 (history) |
| Form: |
Version 2.0 |
| Age: |
42.0 |
| Sex: |
Male |
| Location: |
Nebraska |
| Vaccinated: | 2020-12-15 |
| Onset: | 2020-12-15 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-16 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
RA / SYR |
Administered by: Work Purchased by: ?
Symptoms: Asthenia,
Headache,
Injection site pain,
Malaise,
Nausea
SMQs:, Acute pancreatitis (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Kirkland brand Aller Flo (generic Flonase)
Current Illness: None
Preexisting Conditions: None
Allergies: Seasonal allergies, cats, dogs, dust, ragweed
Diagnostic Lab Data: None
CDC Split Type:
Write-up: I received the vaccine @ 3:40 pm 12-15-20 and felt fine until around 9:00 pm 12-15-20 when I noted headache, nausea, no energy, overall not feeling well, and injection site pain. I did not have a fever. Symptoms still present @ 6:00 am 12-16-20. |
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