|
| VAERS ID: |
911465 (history) |
| Form: |
Version 2.0 |
| Age: |
40.0 |
| Sex: |
Male |
| Location: |
Oregon |
| Vaccinated: | 2020-12-18 |
| Onset: | 2020-12-19 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-29 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / UNK |
LA / - |
Administered by: Unknown Purchased by: ?
Symptoms: Ageusia,
Anosmia,
COVID-19,
Cough,
Dysphonia,
Impaired work ability,
Injection site pain,
Lower respiratory tract congestion,
Oropharyngeal pain,
Pain,
SARS-CoV-2 test positive
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Taste and smell disorders (narrow), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None, Comment: Patient History: No
Allergies:
Diagnostic Lab Data: Test Date: 20201221; Test Name: COVID swab; Test Result: Positive
CDC Split Type: USPFIZER INC2020508949
Write-up: positive COVID-19 test with symptoms; positive COVID-19 test with symptoms; Soreness at injection site; This is a spontaneous report from a contactable nurse (patient). A 40-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on 18Dec2020 17:30 in the left arm at single dose for COVID-19 immunization. There was no medical history or concomitant medications. The patient experienced soreness at injection site, cough, body aches on 19Dec2020; sore throat, voice changes from coughing on 20Dec2020; tested positive for covid on 21Dec2020; mild low congestion, loss of taste and smell on 22Dec2020. The nurse stated that he got the vaccine on Friday (18Dec2020). The next day (19Dec2020) he had common side effects: Soreness at the injection site and body aches, which were expected. He also had a cough on top of that, which progressed to the next day. His body aches and coughing were infrequent. The afternoon of Sunday (20Dec2020), he developed sore throat. Yesterday(21Dec2020), he said he could not work because he was still coughing and had a sore throat. His voice was also changing due to the coughing. He was getting better now. The doctor from Employee Heath said that the cough was concerning so he got a COVID swab test yesterday(21Dec2020), and today (22Dec2020) it came back positive. This morning (22Dec2020) he had loss of taste and smell. He no longer had sore throat or cough. He had the vaccine before the test. He wanted to know where they were at with information on this. Was this being monitored? How did this happen? Was it possible that the test was a false positive because he had the vaccine prior? He would like someone to give him an answer, if the test was a false positive due to the vaccine? His doctor could not tell if the test was legit a positive because of the vaccine. He was not able to work right now. He did not even know if the COVID was from the vaccine or not. Will he get compensation for this? Will his workplace cover his absences? In the case he went to the hospital, will this be considered a work related or vaccine related issue? The outcome of event soreness at injection site was recovered on 21Dec2020. The outcome of event tested positive for COVID was not recovered. The nurse considered the cough was disabling as this was not part of the symptoms to watch for after getting the vaccine. All of the symptoms currently besides the cough are not serious as of now, but it has put him out of work. The nurse considered all other events as non-serious except for cough (disabling). Information on the lot/batch number has been requested.; Sender''s Comments: Based on the information currently available, a lack of efficacy with BNT162B2 in this patient might not be completely excluded. |
|
| VAERS ID: |
911636 (history) |
| Form: |
Version 2.0 |
| Age: |
25.0 |
| Sex: |
Female |
| Location: |
Florida |
| Vaccinated: | 2020-12-22 |
| Onset: | 2020-12-25 |
| Days after vaccination: | 3 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-29 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EH9899 / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Computerised tomogram head,
Erythema,
Full blood count,
Hypoaesthesia,
Magnetic resonance imaging,
Metabolic function test,
Paraesthesia oral,
Swelling face,
Urine analysis
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (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? Yes, 2 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Zyrtec daily. Orillissa daily.
Current Illness:
Preexisting Conditions: Endometrosis, migraines, anxiety
Allergies: Sulfa, and IV contrast dye
Diagnostic Lab Data: MRI and CT of the head to rule out CVA. CMP, CBC, and UA.
CDC Split Type:
Write-up: I received my vaccine on 12/22 around noon. I woke up at 4am this morning 12/25 with tingling in my lips and tongue, in addition to the left side of my face being swollen. Not entirely sure what these side effects are from exactly but thought it best to report my experiences I was hospitalized on 12/25 to 12/26 because my reaction did get worse. I was experiencing numbness on the left side of my body and swelling, numbness, and redness on the left side of my face as well. The hospital didn?t really give any explanations but I?m only now have mild swelling and numbness on the left side of my face. Everything else has resolved at this point in time. |
|
| VAERS ID: |
911829 (history) |
| Form: |
Version 2.0 |
| Age: |
80.0 |
| Sex: |
Female |
| Location: |
Michigan |
| Vaccinated: | 2020-12-28 |
| Onset: | 2020-12-29 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-29 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
- / 1 |
RA / IM |
Administered by: Senior Living Purchased by: ?
Symptoms: Asthenia,
Decreased appetite,
Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (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: Aspirin Tablet 81 MG Give 1 tablet by mouth in the morning Bisoprolol Fumarate Tablet 5 MG Give 1 tablet by mouth in the morning for HTN Flomax Capsule 0.4 MG (Tamsulosin HCl) Give 1 capsule by mouth in the evening Levothyroxine Sodium Ta
Current Illness: U07.1 COVID-19
Preexisting Conditions: F03.91 UNSPECIFIED DEMENTIA WITH BEHAVIORAL DISTURBANCE R26.9 UNSPECIFIED ABNORMALITIES OF GAIT AND MOBILITY M62.81 MUSCLE WEAKNESS (GENERALIZED) Z74.1 NEED FOR ASSISTANCE WITH PERSONAL CARE N13.9 OBSTRUCTIVE AND REFLUX UROPATHY, UNSPECIFIED N13.2 HYDRONEPHROSIS WITH RENAL AND URETERAL CALCULOUS OBSTRUCTION R45.4 IRRITABILITY AND ANGER F06.34 MOOD DISORDER DUE TO KNOWN PHYSIOLOGICAL CONDITION WITH MIXED FEATURES G93.41 METABOLIC ENCEPHALOPATHY I25.10 ATHEROSCLEROTIC HEART DISEASE OF NATIVE CORONARY ARTERY WITHOUT ANGINA PECTORIS F06.2 PSYCHOTIC DISORDER WITH DELUSIONS DUE TO KNOWN PHYSIOLOGICAL CONDITION F06.0 PSYCHOTIC DISORDER WITH HALLUCINATIONS DUE TO KNOWN PHYSIOLOGICAL CONDITION R26.2 DIFFICULTY IN WALKING, NOT ELSEWHERE CLASSIFIED I10 ESSENTIAL (PRIMARY) HYPERTENSION K21.9 GASTRO-ESOPHAGEAL REFLUX DISEASE WITHOUT ESOPHAGITIS E11.9 TYPE 2 DIABETES MELLITUS WITHOUT COMPLICATIONS E78.5 HYPERLIPIDEMIA, UNSPECIFIED E03.9 HYPOTHYROIDISM, UNSPECIFIED F41.9 ANXIETY DISORDER, UNSPECIFIED E11.40 TYPE 2 DIABETES MELLITUS WITH DIABETIC NEUROPATHY, UNSPECIFIED E66.01 MORBID (SEVERE) OBESITY DUE TO EXCESS CALORIES J30.9 ALLERGIC RHINITIS, UNSPECIFIED F33.9 MAJOR DEPRESSIVE DISORDER, RECURRENT, UNSPECIFIED F43.23 ADJUSTMENT DISORDER WITH MIXED ANXIETY AND DEPRESSED MOOD R48.8 OTHER SYMBOLIC DYSFUNCTIONS
Allergies: Latex
Diagnostic Lab Data: N/A
CDC Split Type:
Write-up: Resident found unresponsive in her room. Note from earlier: Resident appears to be weak today. Resident ate a few bites of dinner before refusing the tray. Writer encouraged fluids. Vitals 123/72 80HR BS 166. Will log for Doctor and continue to monitor. Was sent out 911. |
|
| VAERS ID: |
911854 (history) |
| Form: |
Version 2.0 |
| Age: |
70.0 |
| Sex: |
Female |
| Location: |
Connecticut |
| Vaccinated: | 2020-12-23 |
| Onset: | 2020-12-24 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-29 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
011J20A / 1 |
LA / SYR |
Administered by: Private Purchased by: ?
Symptoms: Back pain,
Neck pain,
Pain,
Pain in extremity
SMQs:, Retroperitoneal fibrosis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losarten, pravastan, B-12
Current Illness: High blood pressure, cholestrol
Preexisting Conditions: high blood pressure, cholesterol, obesity
Allergies: allergy to pineapple skin
Diagnostic Lab Data: none
CDC Split Type:
Write-up: I received the vaccine shot on 12/23/20 at 3 pm. By 12/24/20, I had pain in my left arm that radiated to my neck and back on the left side. Over the past 4/5 days, I continue to have pain in my left arm, back and neck |
|
| VAERS ID: |
911943 (history) |
| Form: |
Version 2.0 |
| Age: |
40.0 |
| Sex: |
Female |
| Location: |
North Carolina |
| Vaccinated: | 2020-12-28 |
| Onset: | 2020-12-28 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-29 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL0140 / 1 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Dyspnoea,
Hyperhidrosis,
Palpitations,
Paraesthesia,
Pharyngeal swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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: Lo Loestrin, Hydroxyzine, Folic Acid, Melatonin, Multi Vitamin, and Vitamin D.
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 12/28/2020 Swelling of throat in ED, treated with Epi Pen, 25mg Benadryl and 60mg of Prednisone by mouth. Prednisone prescription 40mg by mouth times 5 days.
CDC Split Type:
Write-up: Adverse reaction post Covid vaccine. Waited for 20 min post vaccine. Experienced S/S Heart palpitations, shortness of breath, tingling in extremities, diaphoretic after leaving clinic observation. Drove back to hospital, escorted by pre surgical testing hospital staff and taken by wheelchair to ED. |
|
| VAERS ID: |
912137 (history) |
| Form: |
Version 2.0 |
| Age: |
32.0 |
| Sex: |
Female |
| Location: |
Florida |
| Vaccinated: | 2020-12-21 |
| Onset: | 2020-12-21 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-29 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / UNK |
- / - |
Administered by: Private Purchased by: ?
Symptoms: Eye swelling,
Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (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, 1 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Trazodone 50mg, Wellbutrin 300mg, lexapro 20mg, AirDuo Respiclick, Albuterol prn
Current Illness:
Preexisting Conditions: asthma, depression, migraines
Allergies: Lobster, hymenoptera
Diagnostic Lab Data:
CDC Split Type:
Write-up: Was given the vaccine and about 5 minutes later started having swelling and my eyes and face. It was watched for a few minutes and was assessed by EMS and taken to the emergency department. I was given epinephrine, Benadryl, Solu-Medrol, Pepcid, IV fluids, DuoNebs and observed overnight. I was given multiple rounds of Benadryl, steroids, Pepcid, DuoNebs |
|
| VAERS ID: |
912271 (history) |
| Form: |
Version 2.0 |
| Age: |
50.0 |
| Sex: |
Male |
| Location: |
Louisiana |
| Vaccinated: | 2020-12-16 |
| Onset: | 2020-12-17 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-29 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EK5730 / 1 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Dyspnoea,
Intensive care,
Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Subject received vaccination Wednesday Dec 16th in the afternoon. He became symptomatic (shortness of breath, low grade fever) the next day. Went to the Emergency room on Saturday Dec. 26th, 2020 due to shortness of breath, had an 02 Sat of 60%, and was hospitalized in the ICU at another hospital (due to bed unavailability). |
|
| VAERS ID: |
912511 (history) |
| Form: |
Version 2.0 |
| Age: |
39.0 |
| Sex: |
Female |
| Location: |
Washington |
| Vaccinated: | 2020-12-28 |
| Onset: | 2020-12-28 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-29 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
- / 1 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Full blood count,
Hypoaesthesia,
Hypoaesthesia oral,
Lip swelling,
Metabolic function test,
Paraesthesia,
Paraesthesia oral,
Swelling of eyelid,
Visual impairment
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zinc 50 mg daily Vitamin D3 5000 IU daily Trazodone 50 mg daily Melatonin 5 mg daily
Current Illness: None
Preexisting Conditions: None
Allergies: Erythromycin
Diagnostic Lab Data: Laboratory results pending. Will check CBC, CMP.
CDC Split Type:
Write-up: Received vaccine at 1:30 pm yesterday, noted onset of symptoms at 8:45 pm. Numbness and tingling to mouth and bilateral upper and lower extremities, mild vision change, feeling of some swelling to bilateral eyelids. Also swelling to lips. She also did take zinc gluconate 50 mg last night and this morning. Has never taken zinc 50 mg, but has taken zinc as component of multivitamin/pre-natal vitamins. Patient was prescribed Pepcid 20 mg BID, Medrol 4 mg dose pack 21 pill taper until complete. Also given Benadryl 25 mg - 50 mg every 4 - 6 hours for allergy symptoms. And provided with an Epi-Pen for home. |
|
| VAERS ID: |
912574 (history) |
| Form: |
Version 2.0 |
| Age: |
97.0 |
| Sex: |
Female |
| Location: |
Ohio |
| Vaccinated: | 2020-12-28 |
| Onset: | 2020-12-29 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-29 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / UNK |
- / - |
Administered by: Public Purchased by: ?
Symptoms: Cardiac arrest,
Endotracheal intubation,
Intensive care
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad), Noninfectious myocarditis/pericarditis (broad)
Life Threatening? Yes
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:
Current Illness: COVID-19 positive on 12/4/2020. Was still symptomatic at last check
Preexisting Conditions: Hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Rushed to ER. Has now been tubed and put into the ICU and has had full-cardiac arrest less than 24 hours after receiving the vaccine. |
|
| VAERS ID: |
912602 (history) |
| Form: |
Version 2.0 |
| Age: |
83.0 |
| Sex: |
Male |
| Location: |
Ohio |
| Vaccinated: | 2020-12-28 |
| Onset: | 2020-12-29 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-29 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / UNK |
- / - |
Administered by: Senior Living Purchased by: ?
Symptoms: Endotracheal intubation,
Intensive care
SMQs:, Angioedema (broad), Respiratory failure (broad)
Life Threatening? Yes
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:
Current Illness: COVID-19 positive 11/30 with fever, sore throat, dyspnea and difficulty breathing
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Hospitalized 12/29, has now been tubed and put into the ICU |
|
