|
| VAERS ID: |
909379 (history) |
| Form: |
Version 2.0 |
| Age: |
28.0 |
| Sex: |
Female |
| Location: |
Pennsylvania |
| Vaccinated: | 2020-12-23 |
| Onset: | 2020-12-23 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-26 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL0140 / 1 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Cardiac monitoring,
Chest X-ray,
Computerised tomogram abdomen,
Computerised tomogram pelvis,
Computerised tomogram thorax,
Electrocardiogram,
Hypotension,
Laboratory test,
Nausea,
Presyncope,
Tachycardia,
Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? Yes, 1 days
Extended hospital stay? No
Previous Vaccinations: mild near syncope at age 18 (2010) after Gardasil dose
Other Medications: bupropion PO 300mg daily fexofenadine PO 180mg daily Mirena IUD
Current Illness:
Preexisting Conditions:
Allergies: sulfa drugs, mango skin
Diagnostic Lab Data: 12/23/20 emergency department lab workup, chest x-ray, chest/abd/pelvis CT scan, EKG x3, inpatient hospital labs, cardiac monitoring
CDC Split Type:
Write-up: near syncope, hypotension, nausea/vomiting, tachycardia (120-150) within 5 minutes of administration. did not resolve and worsened within 1 hour. Pt went to ER for workups. Received IV benadryl without improvement. Admitted to hospital overnight for continuous cardiac monitoring. Improved overnight and discharged in the afternoon 12/24/20. |
|
| VAERS ID: |
909481 (history) |
| Form: |
Version 2.0 |
| Age: |
29.0 |
| Sex: |
Female |
| Location: |
California |
| Vaccinated: | 2020-12-26 |
| Onset: | 2020-12-26 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-27 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
011J20A / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Diarrhoea,
Feeling hot,
Heart rate increased,
Nausea,
Palpitations,
Pharyngeal swelling,
Swollen tongue,
Urticaria,
Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)
Life Threatening? Yes
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: Sulfa
Diagnostic Lab Data: None
CDC Split Type:
Write-up: O had the vaccine at 9 am this morning waited 15 mins after vaccine before leaving while driving I had a pounding heart rate and hot I rolled down the window felt better. 1 hour later while at home.e started with nausea diarrhea rapid heart rate headed to medical office while in care tongue swelled I called 911 pulled over when the ambulance got to me my throat swelled and I had hives on chest they took me emergency while there I had sever pounding heart and vomiting treated with meds sent home with medication and benadryl |
|
| VAERS ID: |
909490 (history) |
| Form: |
Version 2.0 |
| Age: |
28.0 |
| Sex: |
Female |
| Location: |
Washington |
| Vaccinated: | 2020-12-26 |
| Onset: | 2020-12-26 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-27 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
- / IM |
Administered by: Private Purchased by: ?
Symptoms: Anaemia,
Dizziness,
Haemoglobin decreased,
Nausea,
Palpitations,
Sinus tachycardia
SMQs:, Acute pancreatitis (broad), Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Dehydration (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? Yes, ? days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: pollen
Diagnostic Lab Data: Anemia - Hb 9.5 tachycardia 120s
CDC Split Type:
Write-up: The patient developed palpitations, lightheadedness and nausea and came to the ED and was found to have sinus tachycardia. Unclear if it is a vaccine reaction or due to anxiety or severe iron deficiency anemia. |
|
| VAERS ID: |
909577 (history) |
| Form: |
Version 2.0 |
| Age: |
60.0 |
| Sex: |
Female |
| Location: |
Michigan |
| Vaccinated: | 2020-12-26 |
| Onset: | 2020-12-26 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-27 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EK9231 / 1 |
AR / IM |
Administered by: Private Purchased by: ?
Symptoms: Dizziness,
Dyspnoea,
Full blood count,
Laboratory test,
Swelling
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vestibular disorders (broad)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Estrogen, Flonase, Protonix, Glucosamine, Albuterol
Current Illness: Viral respiratory infection
Preexisting Conditions: Allergic rhinitis, GERD, endometriosis
Allergies: Avocado, Banana, Latex, Neosporin, Nystatin, Sulfa, Pineapple
Diagnostic Lab Data: Routine chemistries, CBC
CDC Split Type:
Write-up: Dizziness, dyspnea, neck swelling |
|
| VAERS ID: |
909586 (history) |
| Form: |
Version 2.0 |
| Age: |
48.0 |
| Sex: |
Female |
| Location: |
Texas |
| Vaccinated: | 2020-12-17 |
| Onset: | 2020-12-26 |
| Days after vaccination: | 9 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-27 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EK5730 / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: COVID-19,
Chest X-ray abnormal,
Exposure to SARS-CoV-2,
Pneumonia
SMQs:, Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (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? Yes, ? days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: Chest exam and e-x-ray''s ( hospitalized)
CDC Split Type:
Write-up: The patient was vaccinated on 12/17/20. Wife was diagnosis with COVID-19 on 12/18/20. He was diagnosis with COVID-19 on 12/21/20. Symptoms woresen on 12/26/20. And he had chest exam (x-ray''s), pneumonia bi-lateral and he was hostipalized on 12/26/20. |
|
| VAERS ID: |
909614 (history) |
| Form: |
Version 2.0 |
| Age: |
48.0 |
| Sex: |
Male |
| Location: |
Arizona |
| Vaccinated: | 2020-12-21 |
| Onset: | 2020-12-21 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-27 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EH9899 / 1 |
LA / SYR |
Administered by: Private Purchased by: ?
Symptoms: Heart rate increased,
Hypertension,
Myalgia,
Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypertension (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)
Life Threatening? Yes
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: Bystolic 5mg Atorvastatin
Current Illness:
Preexisting Conditions:
Allergies: Latex
Diagnostic Lab Data:
CDC Split Type:
Write-up: Fever, muscle aches, hypertension, rapid heart heart |
|
| VAERS ID: |
909635 (history) |
| Form: |
Version 2.0 |
| Age: |
46.0 |
| Sex: |
Male |
| Location: |
Maryland |
| Vaccinated: | 2020-12-21 |
| Onset: | 2020-12-22 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-27 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EK5730 / 1 |
LA / IM |
Administered by: Other Purchased by: ?
Symptoms: Atrial fibrillation,
Cardioversion,
Chest discomfort,
Dyspnoea,
Echocardiogram normal,
Palpitations,
Presyncope
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: metformin, Jardiance, Losartan, HCTZ
Current Illness:
Preexisting Conditions: DM, HTN
Allergies: Amoxicillin
Diagnostic Lab Data: Normal echocardiogram
CDC Split Type:
Write-up: Palpitations, shortness of breath, chest tightness, presyncope, which led to New onset atrial fibrillation with rapid ventricular response and required synchronized cardioversion and hospitalization. Discharged on anticoagulation and beta-blocker. |
|
| VAERS ID: |
909720 (history) |
| Form: |
Version 2.0 |
| Age: |
41.0 |
| Sex: |
Male |
| Location: |
Minnesota |
| Vaccinated: | 2020-12-22 |
| Onset: | 2020-12-23 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-27 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EJ1685 / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Abdominal pain lower,
Appendicectomy,
Appendicitis,
Computerised tomogram abnormal,
Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 12/24- CT revealed appendicitis, appendectomy performed
CDC Split Type:
Write-up: 12/23- began to experience intermittent right lower quadrant pain in the morning, fever of 100.4 F in the evening which subsided with ibuprofen. 12/24- no fever noted but intermittent right lower quadrant pain continued, seen at the Health Clinic, sent to Hospital ER for CT scan, diagnosed with appendicitis, appendectomy performed. |
|
| VAERS ID: |
909778 (history) |
| Form: |
Version 2.0 |
| Age: |
20.0 |
| Sex: |
Female |
| Location: |
Virginia |
| Vaccinated: | 2020-12-26 |
| Onset: | 2020-12-26 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-27 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
LA / IM |
Administered by: Work Purchased by: ?
Symptoms: Dysphagia,
Electroencephalogram,
Pruritus,
Psychogenic seizure,
Swollen tongue,
Tongue pruritus,
Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), 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)
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? Yes, 2 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Depovera
Current Illness:
Preexisting Conditions: Asthma
Allergies: Morphine, penicillin, Shellfish, iodine, honey, pollen, dust
Diagnostic Lab Data: EEG
CDC Split Type:
Write-up: 8:27 Hives, itching all over chest and on tongue, tongue swelling, slight difficulty swallowing. 8:30 epi administered/ benedrly 8:32 pseudo seizures begin off and on till the 27th |
|
| VAERS ID: |
909911 (history) |
| Form: |
Version 2.0 |
| Age: |
65.0 |
| Sex: |
Male |
| Location: |
Alaska |
| Vaccinated: | 2020-12-18 |
| Onset: | 2020-12-20 |
| Days after vaccination: | 2 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-28 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EH9899 / 1 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Atrial fibrillation,
Cardioversion,
Echocardiogram,
Electrocardiogram,
Laboratory test
SMQs:, Supraventricular tachyarrhythmias (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? Yes, 3 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: HYDROCHLORIATHIAZIDE 25 MG 1/DAY, ALODAPRINE 5MG 1/DAY
Current Illness: HYPERTENSION
Preexisting Conditions: HYPERTENSION
Allergies: N/A
Diagnostic Lab Data: EKG ECHOCARDIOGRAM ''VARIETY LABS''
CDC Split Type: vsafe
Write-up: 12/20/2020 12:00 PM DEVELOPED LAPID ATRIAL FIB. WENT TO ER WHEN IT PERSISTED, MEDICAL CENTER. ADMITTED TO INPATIENT; 12/21/2020 - ELECTRICAL CARDIOVERSION. MONITORED OVERNIGHT. 12/22/2020 - DISCHARGED *ON CHRONIC BLOOD THINNER |
|
