|
| VAERS ID: |
902780 (history) |
| Form: |
Version 2.0 |
| Age: |
34.0 |
| Sex: |
Female |
| Location: |
California |
| 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 |
UN / IM |
Administered by: Private Purchased by: ?
Symptoms: Rash
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: None
Current Illness: No
Preexisting Conditions: Mild hypertension
Allergies: Sulfa drugs
Diagnostic Lab Data:
CDC Split Type:
Write-up: The patient got a rash on the upper chest and neck approximately 3 hours after vaccination. The rash was self limiting and no treatment currently needed. |
|
| VAERS ID: |
902784 (history) |
| Form: |
Version 2.0 |
| Age: |
48.0 |
| Sex: |
Female |
| Location: |
New Mexico |
| Vaccinated: | 2020-12-16 |
| Onset: | 2020-12-16 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-16 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EK5730 / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Electrocardiogram normal,
Musculoskeletal chest pain
SMQs:
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: None
Current Illness: None
Preexisting Conditions: Depression, Stress Incontinence
Allergies: None
Diagnostic Lab Data: 12/16/20-EKG WNL
CDC Split Type:
Write-up: Pt presents to the ED for c/o L anterior chest wall pain after receiving covid19 vaccination today around 1030. Pt reports she received the first dose in the L bicep. Pt reports after she received that shot she started having L anterior chest wall pain. Pt states she doesn''t have any chest tightness but does have stabbing pain to the L anterior chest wall. Pt denies any difficulty breathing or hives or any allergic reaction. Pt was hooked up to cardiac/sp02 and BP monitoring equipment. Medication: Ibuprofen Route: PO Dose:800 mg Patient tolerated medication well; no adverse reaction noted. Medication: Tylenol Route: PO Dose:975 mg Patient tolerated medication well; no adverse reaction noted. |
|
| VAERS ID: |
902788 (history) |
| Form: |
Version 2.0 |
| Age: |
46.0 |
| Sex: |
Female |
| Location: |
Unknown |
| 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: Influenza like illness,
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Received Pfizer Covid Vaccine - Had fever of 102 and flu like symptoms. Took Tylenol and temp resolved to 99. |
|
| VAERS ID: |
902790 (history) |
| Form: |
Version 2.0 |
| Age: |
31.0 |
| Sex: |
Female |
| Location: |
Kentucky |
| 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: Eye movement disorder,
Hyperhidrosis,
Memory impairment,
Pallor,
Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (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: syncopal episode as child
Other Medications: zyrtec multivitamin vitamin b12
Current Illness: 12/14/20 - seen at urgent care wanting serology tests for covid. No active symptoms of covid reported at that time. Dx covid in July 2020
Preexisting Conditions: vitamin b12 deficiency
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:
Write-up: 11 minutes after first dose of Covid Pfizer vaccine, patient became unresponsive, pale, diaphoretic with possible seizure activity. Patient dropped all belongings, leaned to the left side, with eyes rolling back in her head. Episode lasted about a minute. Patient could not remember what had happened. Vitals were BP 110/60, HR 64, RR 22. Patient was advised to go to ED for further evaluation but she refused. Patient was given a snack and an RN stayed with her for about 20 more minutes to monitor. |
|
| VAERS ID: |
902791 (history) |
| Form: |
Version 2.0 |
| Age: |
51.0 |
| Sex: |
Female |
| Location: |
Kansas |
| 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: Other Purchased by: ?
Symptoms: Dysphagia,
Hypersensitivity,
Hypoaesthesia,
Hypoaesthesia oral,
Paraesthesia,
Paraesthesia oral,
Pharyngeal swelling,
Sensory disturbance,
Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (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: Epi-pen as needed, synthroid
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: Amoxicillin, Bactrim, Erythromycin, Augmentin
Diagnostic Lab Data: none
CDC Split Type:
Write-up: :1039: Responded to notification of potential adverse reaction after receiving COVID-19 vaccination. Pt had been escorted from observation area to emergency area with PA with c/o tightness in throat. On my arrival, pt was eupneic, p/w/d, ambulatory, NAD. Vitals @ 1039: P72, 100% pulse ox on RA Vitals @ 1056: P72, 98% pulse ox on RA, 112/78 seated. Administered 25mg diphenhydramine po per PA @ 1050, pt swallowed with water. Called 911 for EMS response @ 1103 per instruction from provider. Vitals @ 1103: 98% pulse ox on RA, P74, denies shortness of breath or pain. Off phone with EMS @ 1108, en route. EMS on site @ 1115, report given to medic. Pt left with EMS en route to ED @ 1116. Report called to ED Charge Nurse @ 1121. Patient presented to vaccination clinic. Patient received her vaccination at approximately 1021. Patient reports symptoms onset at approximately 1038 with tightness of the throat and difficulty swolowing. She described it as a swelling of the throat sensation. She states she had a sensation moving from her head to her toes as in a "wave ". Patient denied shortness of breath, chest pain denies nausea. Patient denies hives or rashes or pruitis. Patient was assessed and moved to the emergency area. Her symptoms continued with some improvement. At this point time 25 mg of Benadryl was administered orally. Approximately 10 to 15 minutes after administration the patient developed numbness tingling around the upper lip, the right upper extremity. She denied shortness of breath or chest pain. She denied increasing severity of the throat sensations. Pertinent past medical history: Reactions bee stings currently carries EpiPen. She is not had any previous reactions to vaccinations. Allergic reaction. The patient symptoms seem to continue with the numbness tingling around the lips after administration of the Benadryl. Hand tingling of the right upper extremity also continued although it was decreasing. Her symptoms of the tightness of the throat remain the same. She did not develop shortness or breath or chest tightness or pain. At this time I feel be prudent to evacuate the patient to higher level care. Patient was evacuated at 11:16 by ambulance service. |
|
| VAERS ID: |
902792 (history) |
| Form: |
Version 2.0 |
| Age: |
31.0 |
| Sex: |
Female |
| Location: |
California |
| 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 / - |
Administered by: Private Purchased by: ?
Symptoms: Dizziness,
Nausea,
Palpitations
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad)
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: OCP, zyrtec
Current Illness: none
Preexisting Conditions: eczema
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:
Write-up: 1-2 minutes later patient felt nausea, palpitations, and lightheaded |
|
| VAERS ID: |
902793 (history) |
| Form: |
Version 2.0 |
| Age: |
71.0 |
| Sex: |
Female |
| Location: |
Washington |
| 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 |
EK5U30 / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Asthenia,
Blood glucose normal,
Dizziness,
Fatigue,
Hypoaesthesia oral,
Impaired work ability,
Malaise,
Oropharyngeal discomfort,
Pharyngeal hypoaesthesia,
Respiratory tract irritation,
Tongue discomfort
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Vestibular 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: Tetanus shot. Near death experience. Saw tunnel, white light, passed relatives, God. Transient neurological problem lasting abou
Other Medications: Lisinopril 20mg, Atorvastatin 80mg, Metformin 500mg, ASA 81mg, centrum silver multivitam, folic acid 1000 mcg, D3 25 mcg (1000 IU), calcium 1200 mg, fish oil 1200mg
Current Illness: Respiratory illness, quaranteened and test covid 19 negative. Diarrhea. Quaranteened & tested covid 19 negative
Preexisting Conditions: Hypertension, High cholesterol, Type 2 diabetes, previous uterine cancer 20 years ago, resolved
Allergies: Severe reaction to Tetanus shot, after receiving previous shot without problems. Undiagnosed seasonal allergies
Diagnostic Lab Data: None
CDC Split Type:
Write-up: My symptoms started about 15 minutes after shot. Initially I felt slight dizziness begin in my head. Then I felt slight uncomfortable feeling in my lungs, throat, and tongue. They were very slight so I left the vaccine center about 25 minutes after injection. On drive home my lips started to feel numb as well as my tongue & throat. Arriving home very tired. BP 135/ 80 P70 R20 T97.6 Blood sugar 101. Slept for about 4 hours. Called in sick for 7PM shift. Too weak & tired. |
|
| VAERS ID: |
902794 (history) |
| Form: |
Version 2.0 |
| Age: |
35.0 |
| Sex: |
Male |
| 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 |
- / IM |
Administered by: Private Purchased by: ?
Symptoms: Erythema,
Swollen tongue,
Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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: Atorvastatin, Cilostazol, Dextroamphetamine/amphetamine; emtricitabine/tenofovir, ergocalciferol, lisinopril, warfarin.
Current Illness:
Preexisting Conditions: Anti-phospholipid syndrome, Hypertension, Sleep Apnea, Lupus anticoagulant ab positive, H/O MI.
Allergies: Niacin (palpitations)
Diagnostic Lab Data:
CDC Split Type:
Write-up: "Pfizer-BioNTech COVID-19 Vaccine EUA": Acute onset of tongue swelling, throat tightness, and diffuse erythema approximately 5 minutes after receiving COVID-19 vaccine. Patient transferred to emergency department. Patient treated with Epinephrine 0.3 mg IM X1 dose, Dexamethasone 10 mg IV x1 dose, Diphenhydramine 25 mg IV x1 dose. Patient discharged same day with resolution of symptoms. |
|
| VAERS ID: |
902795 (history) |
| Form: |
Version 2.0 |
| Age: |
31.0 |
| Sex: |
Male |
| Location: |
Massachusetts |
| 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: Device connection issue,
Product design issue,
Product quality issue,
Syringe issue
SMQs:, Medication errors (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: When injecting the vaccine fluid, the vaccine administrator noted about 4 drops of liquid that leaked from the area of the syringe tip / needle hub connection. This particular dose was administered by a pharmacist who has experience administering vaccines. In speaking with a few other nurses who administered COVID-19 Pfizer vaccinations at the same clinic (this was the first clinic day), the consensus was that they all did not like the syringes/needles provided by Pfizer. It was a shared opinion that they felt "cheap" and "flimsy". Going forward, our site is not going to use the Pfizer supplied syringes/needles but will be using our own syringes and needles for vaccine administration. |
|
| VAERS ID: |
902796 (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 |
EH9899 / 1 |
LA / SYR |
Administered by: Private Purchased by: ?
Symptoms: Condition aggravated,
Feeling abnormal,
Hot flush,
Injection site pain,
Malaise,
Migraine,
Vomiting
SMQs:, Acute pancreatitis (broad), Dementia (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Methylphenidate Citalopram Buspirone Tylenol
Current Illness: None
Preexisting Conditions: I normally get a migraine a day or two after I insert my NuvaRing. I inserted it on Monday, 12/14/2020 and I think all my symptoms are related to that rather than the vaccination.
Allergies: None
Diagnostic Lab Data:
CDC Split Type:
Write-up: I inserted my NuvaRing birth control on 12/14/2020. I have the Covid19 vaccine on 12/15/2020 at about 8:30am. The injection site was mildly sore and that continued into the next day. I woke up on 12/16/2020 feeling a little off and it progressed throughout the day. I felt a headache that I knew was turning into a migraine, threw up a few times (this is normal for me when I get migraines), and started having hot flashes. My temperature never went above 98. After sleeping a few hours and taking some Excedrin migraine I was feeling much better, though still a little sickly, by 4pm. I really think this is due to my migraines (which I get roughly once a month) even though it was a day later than normal. |
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