|
| VAERS ID: |
902798 (history) |
| Form: |
Version 2.0 |
| Age: |
72.0 |
| Sex: |
Male |
| Location: |
North Carolina |
| 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 |
EJ 1685 / 1 |
RA / IM |
Administered by: Other Purchased by: ?
Symptoms: Circumstance or information capable of leading to medication error,
Contraindicated product administered
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Patient marked that he had received the flu vaccine 7 days ago. This was missed on screening procedure and patient received the vaccine today. Contacted the CDC and instructed to enter a VAERS report. |
|
| VAERS ID: |
902799 (history) |
| Form: |
Version 2.0 |
| Age: |
66.0 |
| Sex: |
Male |
| 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 |
AR / IM |
Administered by: Private Purchased by: ?
Symptoms: Asthenia,
Diarrhoea,
Malaise
SMQs:, Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (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: Nausea in the morning prior to coming to work and receiving vaccination.
Preexisting Conditions:
Allergies: No known
Diagnostic Lab Data:
CDC Split Type:
Write-up: Patient was feeling nauseated in the morning prior to coming to work and prior to receiving vaccine. He had a banana thinking he would feel better. He then received the vaccine and felt progressively worse experiencing diarrhea, weakness, and malaise. |
|
| VAERS ID: |
902810 (history) |
| Form: |
Version 2.0 |
| Age: |
22.0 |
| Sex: |
Female |
| Location: |
Idaho |
| 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: Anxiety,
Blood pressure increased,
Dizziness,
Dyspnoea,
Injection site pain
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Hypertension (narrow), Cardiomyopathy (broad), Vestibular 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Altavera .15mg to .3mg PRN Nasonex PRN Proair HFA PRN
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data: BP 150/100 (has been high since having COVID in June 2020), HR 150
CDC Split Type:
Write-up: Patient complained of feeling dizzy, anxious, shortness of breath. Did have some pain with injection. Did have mask on while waiting standard 15 minutes. |
|
| VAERS ID: |
902811 (history) |
| Form: |
Version 2.0 |
| Age: |
39.0 |
| 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 / UNK |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Fall,
Seizure like phenomena
SMQs:, Convulsions (narrow), Accidents and injuries (narrow)
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:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Associate received vaccine at 12:15 pm and was monitored for 15 minutes. After 15 minutes, associate went to check out table. While at check out table, associate fell to ground and was experiencing seizure like activity. Supportive treatment was administerd and associate was transferred to ED. |
|
| VAERS ID: |
902813 (history) |
| Form: |
Version 2.0 |
| Age: |
49.0 |
| Sex: |
Female |
| Location: |
Illinois |
| 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 |
- / 1 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Asthenia,
Dizziness,
Fatigue
SMQs:, Anticholinergic syndrome (broad), 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:
Other Medications: Womans one a day multivitamin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type:
Write-up: Dizziness that lasted for about an hour. Weakness, extreme fatigue lasted the rest of the day. |
|
| VAERS ID: |
902815 (history) |
| Form: |
Version 2.0 |
| Age: |
51.0 |
| Sex: |
Male |
| Location: |
Arizona |
| 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: Other Purchased by: ?
Symptoms: Flushing,
Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Eosinophilic pneumonia (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None, patient asymptomatic when he arrived to ER for evaluation.
CDC Split Type:
Write-up: Feeling flush and wheezing when walking. |
|
| VAERS ID: |
902818 (history) |
| Form: |
Version 2.0 |
| Age: |
40.0 |
| Sex: |
Female |
| Location: |
Illinois |
| 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: Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC Split Type:
Write-up: Patient was in observation area after admistration of covid vaccine. At 15 Minute mark patient stated throat felt tight and like it was closing up. Assesment of patient showed tongue PWD, vital signs as follows. 97.6, 118/72, 66 pulse and 100% pulse oxygenation. Observed patient for 15 minutes more, gave patient water and monitored for full 30 minutes. Breathing normal at this time. States feeling better. Discharged and advised to monitor throughout night and if worse go to emergency room. Patient agreed and stated understanding. |
|
| VAERS ID: |
902821 (history) |
| Form: |
Version 2.0 |
| Age: |
33.0 |
| 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 |
- / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Fatigue,
Myalgia,
Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: CT contrast
Diagnostic Lab Data:
CDC Split Type:
Write-up: Fatigue, nausea, muscle aches |
|
| VAERS ID: |
902823 (history) |
| Form: |
Version 2.0 |
| Age: |
73.0 |
| Sex: |
Male |
| Location: |
West 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 |
EU9899 / UNK |
LA / IM |
Administered by: Senior Living Purchased by: ?
Symptoms: Injection site erythema
SMQs:, Extravasation events (injections, infusions and implants) (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: Oxybutynin 5mg daily, Eliquis 5mg BID, Prazosin HCL 2mg QHS, Finasteride 5mg QHS, Imdur 15 g day, Zyrtec 10mg QHS, MOM 45ml daily, Klorcon 30mg BID, Lyrica 150mg BID, Lasix 80mg daily and 60mg QPM, UTI Stat 30ml daily, Flonase 50mg BID, Bu
Current Illness:
Preexisting Conditions: DM2, hx of PE, Central Cord Syndrome, Cervical Disc Degeneration
Allergies: Sulfa
Diagnostic Lab Data: none
CDC Split Type:
Write-up: Redness at injection site |
|
| VAERS ID: |
902824 (history) |
| Form: |
Version 2.0 |
| Age: |
28.0 |
| Sex: |
Male |
| Location: |
Colorado |
| 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: Work Purchased by: ?
Symptoms: Headache,
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: None
Current Illness: None
Preexisting Conditions: Hypertension
Allergies: Cephalosporins
Diagnostic Lab Data:
CDC Split Type:
Write-up: Headache, body aches, low grade fever (99.3 F) |
|
