|
| VAERS ID: |
902758 (history) |
| Form: |
Version 2.0 |
| Age: |
43.0 |
| Sex: |
Male |
| Location: |
Alaska |
| 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: Abnormal sensation in eye,
Blood test,
Dizziness,
Dry mouth,
Euphoric mood,
Periorbital swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Corneal disorders (broad), Vestibular disorders (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: MVI- generic brand
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: blood drawn. un sure of test ordered.
CDC Split Type:
Write-up: @ ~5 min felt cotton mouth. Got up to ask if he could go early. Then at 10 min post injection, felt eyes feeling weird and he felt "high". As in lightheaded. @ 10 min, skin surrounding the eyes are puffy. Given 25 mf benedryl. No immediate SOB or wheeze. No lip or mouth or throat swelling. Taken to ED. Given IM epi 1:1000 0.3ml. Pepcid and more benedryll PO. |
|
| VAERS ID: |
902759 (history) |
| Form: |
Version 2.0 |
| Age: |
44.0 |
| Sex: |
Female |
| Location: |
Indiana |
| 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 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Arthralgia,
Chills,
Injected limb mobility decreased,
Injection site swelling,
Pain,
Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Protein Shake whey, Hair, skin and nail Vitamins
Current Illness: Fever and chills, but was not diagnosed with a illness
Preexisting Conditions: Chiari malformation , Inflammatory bowel disease.
Allergies: None
Diagnostic Lab Data: None
CDC Split Type: vsafe
Write-up: Fever , chills, Body Ache all over body, Joint Pain (worse in hips ) Injection site swollen The PT cannot life her arm |
|
| VAERS ID: |
902760 (history) |
| Form: |
Version 2.0 |
| Age: |
32.0 |
| Sex: |
Female |
| Location: |
Rhode Island |
| 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 |
EH9899 / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Injection site pain,
Injection site pruritus
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: NKA
Diagnostic Lab Data:
CDC Split Type:
Write-up: Burning and itching at injection site |
|
| VAERS ID: |
902763 (history) |
| Form: |
Version 2.0 |
| Age: |
59.0 |
| Sex: |
Female |
| Location: |
Rhode Island |
| 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 |
EH9899 / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Injection site pain,
Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (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: HCTZ, gabapentin
Current Illness: None
Preexisting Conditions:
Allergies: latex, thimerosal
Diagnostic Lab Data:
CDC Split Type:
Write-up: Soreness and swelling at injection site |
|
| VAERS ID: |
902764 (history) |
| Form: |
Version 2.0 |
| Age: |
71.0 |
| Sex: |
Female |
| Location: |
North Carolina |
| 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 / UNK |
- / - |
Administered by: Military Purchased by: ?
Symptoms: Injection site bruising,
Injection site pain,
Injection site swelling
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (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: Levothyroxine 88MCG/once daily, Losartan 100MG/once daily, PravastatinSodium 20MG/once daily, Protonix40MG/twice daily, aspirin 81MG/once daily, Calcium1000, Magnesium400,Zinc15/once daily
Current Illness: None
Preexisting Conditions: Controlled by medication: high blood pressure, thyroid, heartburn, leg cramps
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:
Write-up: .5 inch bruise at injection site, slight swelling, sore muscle, ibuprofen, ice bag, |
|
| VAERS ID: |
902766 (history) |
| Form: |
Version 2.0 |
| Age: |
65.0 |
| Sex: |
Female |
| Location: |
Missouri |
| 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 |
EH9899 / 1 |
RA / IM |
Administered by: Work Purchased by: ?
Symptoms: Chest discomfort,
Cough,
Immediate post-injection reaction,
Vaccination site bruising,
Vaccination site haemorrhage,
Wheelchair user
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hypersensitivity (narrow)
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:
Allergies: Penicillins, Crestor (Rosuvastatin)
Diagnostic Lab Data:
CDC Split Type:
Write-up: Vaccinator Nurse noted upon vaccination there was bleeding from site and immediate bruising. Extended post vaccination monitoring to 30 minutes and asked patient to not leave before being reevaluated. Visual monitoring in post vaccination space by this RN. ? Upon reassessment @ 1352 pt stated she felt the need to use her inhaler and chest tightness. Pt denies SOB and able to transfer independently to wheelchair. Pt began to cough and was immediately transferred to ED per FNP. ? ? Upon ED arrival, pt was transferred to back hall 9, report given to RN and assessed by physician. Vital signs 98% on RA, t- 98.2, HR 78. |
|
| VAERS ID: |
902768 (history) |
| Form: |
Version 2.0 |
| Age: |
42.0 |
| Sex: |
Female |
| Location: |
Texas |
| 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 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Heart rate decreased,
Nausea,
Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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:
Current Illness:
Preexisting Conditions:
Allergies: Ciprofloxacin-rash Pregablin-insomnia
Diagnostic Lab Data:
CDC Split Type:
Write-up: Nausea, tremors, and decrease in HR. Patient taken to ED. No epinephrine injection administered. |
|
| VAERS ID: |
902770 (history) |
| Form: |
Version 2.0 |
| Age: |
50.0 |
| Sex: |
Female |
| Location: |
Arkansas |
| 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 |
EH9899 / 1 |
AR / IM |
Administered by: Private Purchased by: ?
Symptoms: Pruritus,
Rash maculo-papular
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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Lisinopril, Loracarbef, warfarin, Bydureon pen
Diagnostic Lab Data:
CDC Split Type:
Write-up: Patient started to develop maculopapular rash and itching starting ~15 minutes after the vaccine administration. The patient did not report shortness of breath or other respiratory symptoms. The patient was given IV diphenhydramine 50 mg, famotidine 20 mg IV, and methylprednisolone 125 mg IV. The patient''s symptoms resolved and was sent home with a Medrol dose pack and antihistamine. |
|
| VAERS ID: |
902777 (history) |
| Form: |
Version 2.0 |
| Age: |
45.0 |
| Sex: |
Female |
| Location: |
Indiana |
| 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 |
- / UNK |
- / - |
Administered by: Work Purchased by: ?
Symptoms: Erythema,
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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Viibryd, synthroid, Zyrtec, fish oil
Current Illness: none known
Preexisting Conditions:
Allergies: sulfa
Diagnostic Lab Data:
CDC Split Type:
Write-up: redness, itching to face, armpit, and neck |
|
| VAERS ID: |
902778 (history) |
| Form: |
Version 2.0 |
| Age: |
56.0 |
| 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 |
EH789592671001 / 1 |
LA / IM |
Administered by: Work Purchased by: ?
Symptoms: Blood pressure increased,
Headache,
Immediate post-injection reaction,
Injection site hypoaesthesia,
Injection site swelling
SMQs:, Neuroleptic malignant syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: metformin, glipizide, atorvastatin, ozempic, singulair, xopanex inhaler, xopenax nebulizer, epipen, flonase, pepcid AC, levothyroxine
Current Illness: radiation
Preexisting Conditions: Asthma, Diabetes, Capillary thyroid cancer (remission)
Allergies: shrimp, shellfish
Diagnostic Lab Data: No
CDC Split Type: vsafe
Write-up: Swelling and numbness at injection side. Increased blood pressure 199/99. Immediate headache. Workplace clinic called hospital ER, clinic administered Benadryl. Symptoms resolved. |
|
