|
| VAERS ID: |
903133 (history) |
| Form: |
Version 2.0 |
| Age: |
30.0 |
| Sex: |
Female |
| Location: |
Unknown |
| Vaccinated: | 2020-12-17 |
| Onset: | 2020-12-17 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EK5730 / 1 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Blood pressure increased,
Dyspnoea,
Flushing,
Heart rate increased,
Tachycardia
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Hypertension (narrow), Cardiomyopathy (broad), Hypersensitivity (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: 1204 Patient became flushed and started saying she was having a difficult time "catching her breath". She then became tachycardic (upper 90''s- low 100''s). 1205 Benadryl given (25mg). Physician called down to clinic. Vital signs obtained and showed increased BP (145/90) and pulse. 1214 Patient verbalized she was feeling a little better. Monitoring continued until 1245, vital signs were improving and patient no longer had symptoms. She was released at 1252 but encouraged to seek medical attention if she developed new symptoms or had symptoms reoccur. |
|
| VAERS ID: |
903134 (history) |
| Form: |
Version 2.0 |
| Age: |
34.0 |
| Sex: |
Female |
| Location: |
Indiana |
| Vaccinated: | 2020-12-17 |
| Onset: | 2020-12-17 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EJ1685 / 1 |
LA / IM |
Administered by: Work Purchased by: ?
Symptoms: Chest discomfort,
Cough,
Dyspnoea,
Flushing,
Rash
SMQs:, Anaphylactic reaction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown. Inhaler use for asthma.
Current Illness: Unknown
Preexisting Conditions: Asthma
Allergies: Penicillin causes hives and shortness of breath
Diagnostic Lab Data: Diphenhydramine 25mg po liquid and rapid response transportation to emergency room
CDC Split Type: vsafe
Write-up: At 24 minutes after vaccination, pt experienced chest tightness, shortness of breath, cough, flushing, and rash on chest and neck. |
|
| VAERS ID: |
903135 (history) |
| Form: |
Version 2.0 |
| Age: |
29.0 |
| Sex: |
Female |
| Location: |
Puerto Rico |
| Vaccinated: | 2020-12-15 |
| Onset: | 2020-12-16 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Dysstasia,
Fatigue,
Injection site pain,
Malaise,
Muscle spasms,
Nausea,
Palpitations
SMQs:, Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (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: Centrum for women, imotidine, albuterol as needed
Current Illness: None
Preexisting Conditions: asthma, GERD, hypoglicemic
Allergies: Crab
Diagnostic Lab Data: None
CDC Split Type: vsafe
Write-up: woke up the next day and felt nauseated, could not stand up, my heart started racing, I had to lay down, felt cramping, extreme fatigue, felt overall sick, and the pain at the injection site. No fever. Just lasted that day. Feel better today. |
|
| VAERS ID: |
903138 (history) |
| Form: |
Version 2.0 |
| Age: |
36.0 |
| Sex: |
Female |
| Location: |
Iowa |
| Vaccinated: | 2020-12-16 |
| Onset: | 2020-12-16 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Injection site urticaria
SMQs:, Anaphylactic reaction (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: during the administration of vaccine patient developed a wheal at the site on injection. Pressure and message reduced the wheal. |
|
| VAERS ID: |
903139 (history) |
| Form: |
Version 2.0 |
| Age: |
63.0 |
| Sex: |
Female |
| Location: |
Texas |
| Vaccinated: | 2020-12-15 |
| Onset: | 2020-12-16 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Abdominal pain upper,
Arthralgia,
Body temperature increased,
Chills,
Diarrhoea,
Headache
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), 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: Zyrtec 10mg, Lisinopril 10mg, singular 10mg, Cynthroid, Vitamin D 10000 units
Current Illness: NA
Preexisting Conditions: Ebstin Barr
Allergies: Latex
Diagnostic Lab Data: NA
CDC Split Type: vsafe
Write-up: Today I have really bad stomach cramps and diarrhea. Yesterday I had a temp 101.2 with tylenol, chills, joint pain and really bad headache |
|
| VAERS ID: |
903140 (history) |
| Form: |
Version 2.0 |
| Age: |
29.0 |
| Sex: |
Female |
| Location: |
Oklahoma |
| Vaccinated: | 2020-12-16 |
| Onset: | 2020-12-16 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Headache,
Injection site pain,
Nausea
SMQs:, Acute pancreatitis (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: birth control, Allegra and singular, lysin
Current Illness: none
Preexisting Conditions: none
Allergies: sulfa causes vomiting
Diagnostic Lab Data: none
CDC Split Type: vsafe
Write-up: Caller stated after injection at bout 9pm caller had severe headache with nausea and pain at injection site . Caller stated this morning she felt a bit better. |
|
| VAERS ID: |
903142 (history) |
| Form: |
Version 2.0 |
| Age: |
59.0 |
| Sex: |
Female |
| Location: |
Iowa |
| Vaccinated: | 2020-12-16 |
| Onset: | 2020-12-16 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
MRNA BNT-162B2 / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Hypoaesthesia,
Muscular weakness,
Sensation of foreign body
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Sexual dysfunction (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: celebrex bactrim
Current Illness: leg abcess
Preexisting Conditions: reflux
Allergies: Tape, Tetracycline
Diagnostic Lab Data:
CDC Split Type:
Write-up: Pt showed for Covid Vasc #1, received the immunization in left deltoid. minutes later, felt numbness, in arm, the a lump in the throat. Denied SOB, or Dyspnea. Patient the stated weakness in the legs. Assisted to the restroom, x 1. no difficulty. after 30 minutes and no relief from symptoms, patient was wheelchaired over to urgent care, and treated there. Patient was able to leave urgent care on her own, with no problems Patient transferred to urgent care for evaluation. Left from urgent care on her own |
|
| VAERS ID: |
903143 (history) |
| Form: |
Version 2.0 |
| Age: |
44.0 |
| Sex: |
Female |
| Location: |
New York |
| Vaccinated: | 2020-12-17 |
| Onset: | 2020-12-17 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Limb discomfort,
Neurological examination normal,
Paraesthesia
SMQs:, Peripheral neuropathy (broad), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Prilosec
Current Illness:
Preexisting Conditions: GERD
Allergies: none
Diagnostic Lab Data: Monitoring of vital signs. Neurologic exam within normal limits.
CDC Split Type:
Write-up: Employee had tingling sensation in Right upper extremity, and heaviness in bilateral lower extremities 5 minutes after receiving vaccine. These symptoms resolved approximately 2 hours after they began |
|
| VAERS ID: |
903144 (history) |
| Form: |
Version 2.0 |
| Age: |
56.0 |
| Sex: |
Female |
| Location: |
Kansas |
| Vaccinated: | 2020-12-17 |
| Onset: | 2020-12-17 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EK5730 / 1 |
LA / IM |
Administered by: Other 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: Vitamin-multi, Meprozole, Cholesterol medication
Current Illness: no
Preexisting Conditions: High Cholesterol
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:
Write-up: Patient states she got a headache 30 minutes after taking the vaccine. Checked on patient 4 hours later, still complaining of a headache. |
|
| VAERS ID: |
903145 (history) |
| Form: |
Version 2.0 |
| Age: |
34.0 |
| Sex: |
Female |
| Location: |
West Virginia |
| Vaccinated: | 2020-12-15 |
| Onset: | 2020-12-15 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EH9899 / 1 |
LA / IM |
Administered by: Work Purchased by: ?
Symptoms: Pruritus,
Rash,
Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Insulin R, Lantus
Current Illness: None
Preexisting Conditions: Type I Diabetes
Allergies: Clindamycin, compazine
Diagnostic Lab Data: None
CDC Split Type:
Write-up: Developed a couple of hives, rash, and itching 40 minutes after vaccination. Relieved with one dose of oral benadryl. Employee reports symptoms have mostly resolved as of 12/16/20 with some intermittent itching that is relieved with benadryl oral. |
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