|
| VAERS ID: |
902725 (history) |
| Form: |
Version 2.0 |
| Age: |
80.0 |
| Sex: |
Male |
| Location: |
Virginia |
| Vaccinated: | 2020-12-14 |
| Onset: | 2020-12-16 |
| Days after vaccination: | 2 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-16 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Mobility decreased,
Pain in extremity
SMQs:, Parkinson-like events (broad), Tendinopathies and ligament disorders (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: I take one baby asprin daily, one fish oil pill daily and one vitamin c tablet daily
Current Illness: No illnesses
Preexisting Conditions: No
Allergies: I don''t have any allergies to medications or food.
Diagnostic Lab Data: None
CDC Split Type:
Write-up: I experienced a sore arm and could not lift my arm. |
|
| VAERS ID: |
902728 (history) |
| Form: |
Version 2.0 |
| Age: |
34.0 |
| 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 |
PAA156057 / 1 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Peripheral swelling,
Product administered at inappropriate site
SMQs:, Cardiac failure (broad), Angioedema (broad), Drug abuse and dependence (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Medication errors (narrow)
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: BCPs (birth control pills)
Current Illness: None
Preexisting Conditions: MigRaines as 12/16/20
Allergies: Penicillin + Sulfa
Diagnostic Lab Data: (-)
CDC Split Type:
Write-up: Swelling on arm. Placement lower than deltoid, 4 cm. treated with corticosteroids, antihistamines |
|
| VAERS ID: |
902733 (history) |
| Form: |
Version 2.0 |
| Age: |
55.0 |
| Sex: |
Female |
| Location: |
New York |
| Vaccinated: | 2020-12-16 |
| Onset: | 2020-12-16 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-16 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EK5730 / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Dysgeusia,
Immediate post-injection reaction,
Myalgia,
Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Taste and smell disorders (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (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: Synthroid
Current Illness:
Preexisting Conditions: Hypothyroidism
Allergies: Laytex, Beestings, Tape
Diagnostic Lab Data: BP 107/70 99% O2 on RA HR 49
CDC Split Type:
Write-up: Pt started to have a metallic taste in her mouth immediately after administration of the Covid-19 vaccine. She started to feel nauseous and myalgias. The patient was seated, given Zofran 4mg once and Benadryl 25 mg once. After 10 min patient was eating juice + crackers. Reports she feels better. A co-worker verbalized he would drive her home, patient agreed. |
|
| VAERS ID: |
902744 (history) |
| Form: |
Version 2.0 |
| Age: |
34.0 |
| Sex: |
Female |
| Location: |
Texas |
| 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 |
EK5730 / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Abdominal pain upper,
Headache,
Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
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: Penicillin
Diagnostic Lab Data: n/a
CDC Split Type: vsafe
Write-up: 12/15/2020 5:00 PM Nauseas(worst ) 5:30 Pm Headache 6:00 Pm Stomach Pain |
|
| VAERS ID: |
902745 (history) |
| Form: |
Version 2.0 |
| Age: |
43.0 |
| Sex: |
Female |
| Location: |
Puerto Rico |
| Vaccinated: | 2020-12-15 |
| Onset: | 2020-12-16 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-16 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EH9899 / 1 |
LA / IM |
Administered by: Work Purchased by: ?
Symptoms: Injected limb mobility decreased,
Injection site oedema,
Injection site pain,
Musculoskeletal chest pain,
Myalgia,
Pain,
Painful respiration,
Paraesthesia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: ASTHMA, SLEEP APNEA, PSEUDOMOTOR CEREBRI
Allergies: DEMEROL
Diagnostic Lab Data:
CDC Split Type:
Write-up: PAIN AND EDEMA AT SITE OF INJECTION LEFT ARM WITH DECREASED RANGE OF MOTION LEFT ARM RIB CAGE PAIN ON INSPIRATION MUSCLE PAIN RIGHT AND LEFT THIGHS, WORSENING UPON AMBULATION MUSCLE PAIN AND TINGLING RIGHT UPPER EXTREMITY AND BACK |
|
| VAERS ID: |
902746 (history) |
| Form: |
Version 2.0 |
| Age: |
37.0 |
| Sex: |
Female |
| Location: |
Florida |
| 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 |
EH9989 / 1 |
LA / IM |
Administered by: Pharmacy Purchased by: ?
Symptoms: Hyperhidrosis,
Hypotension,
Pallor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (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: Escitalopram 10 mg po daily
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: No known allergies
Diagnostic Lab Data: N/A
CDC Split Type:
Write-up: Following first dose, patient became hypotensive, pale, and diaphoretic. Denies syncope. Patient went to nearby emergency department at Hospital. Was monitored for several hours and was discharged in stable condition. |
|
| VAERS ID: |
902748 (history) |
| Form: |
Version 2.0 |
| Age: |
34.0 |
| Sex: |
Female |
| Location: |
Pennsylvania |
| 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 |
PA156051 / 1 |
RA / - |
Administered by: Private 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: Levothyroxine , Wellbutrin , Bustar, trazodone , Lithium Carbonate ER , vistaril , Propranolol, MAXALT
Current Illness: COVID one week before
Preexisting Conditions: Bipolar Disorder
Allergies: NA
Diagnostic Lab Data: N/a
CDC Split Type: vsafe
Write-up: Chills, Body Ache, Fever |
|
| VAERS ID: |
902750 (history) |
| Form: |
Version 2.0 |
| Age: |
26.0 |
| Sex: |
Male |
| Location: |
New York |
| 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 |
- / UNK |
- / - |
Administered by: Work Purchased by: ?
Symptoms: Chills,
Fatigue,
Headache,
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:
Current Illness: COVID19+ 3 weeks prior to the vaccine
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: The employee experienced headaches the evening after receiving the vaccine. The next morning he experienced improvements in the headaches but developed chills, fatigue, and fever, all of which have improved somewhat by the afternoon when he reported these adverse effects to our employee health service. As he is recently recovered from COVID, a repeat COVID test may not be helpful. He was advised to call our employee health service and followup with his own doctor if these symptoms do not improve or resolve after 3 days. |
|
| VAERS ID: |
902755 (history) |
| Form: |
Version 2.0 |
| Age: |
32.0 |
| Sex: |
Male |
| Location: |
Virginia |
| Vaccinated: | 2020-12-16 |
| Onset: | 2020-12-16 |
| 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 |
EJ6185 / 1 |
LA / SYR |
Administered by: Private Purchased by: ?
Symptoms: Headache
SMQs:
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:
CDC Split Type:
Write-up: Headache, onset ~45 minutes after injection |
|
| VAERS ID: |
902757 (history) |
| Form: |
Version 2.0 |
| Age: |
31.0 |
| Sex: |
Female |
| Location: |
South Dakota |
| 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: Private Purchased by: ?
Symptoms: Disturbance in attention,
Headache,
Impaired work ability,
Pain in extremity,
Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Tendinopathies and ligament disorders (broad), 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? No
Hospitalized? No
Previous Vaccinations: Flu shots, I passed out right after in 2017. Gardisil I passed out a minute or two and was over 10 years ago
Other Medications: Loestregal, fluoexetine, Vitamin B, Vitamin D
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type: vsafe
Write-up: I got it about 10 am I went home I attempted to work from home for about an hour and had a headache, took a 3 hour nap and felt much better after waking up, I felt like I couldn''t concentrate. I felt fine this morning 12/16/2020 and I went to work just fine. I don''t have a headache and don''t feel like I need a nap, my arm still hurts but that is usual. I called my provider and asked if I could take Tylenol, but they were unsure so I did not take medication |
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