|
| VAERS ID: |
912609 (history) |
| Form: |
Version 2.0 |
| Age: |
46.0 |
| Sex: |
Female |
| Location: |
Indiana |
| 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 |
EK5730 / 1 |
- / IM |
Administered by: Private Purchased by: ?
Symptoms: Cardiac monitoring abnormal,
Dizziness,
Flushing,
Heart rate increased,
Supraventricular tachycardia,
Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (broad), Dehydration (broad), Noninfectious myocarditis/pericarditis (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? Yes, ? days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Patient observed for 15 minutes in the clinic after vaccine with no issues. Patient is a NP and left clinic. 10 min after leaving, was in physician lounge and had tachycardia, dizziness, flushing. Hospitalist in lounge recorded pulse as 180 normal rhythm. Patient taken to ED. In SVT - heart rate eventually reduced. Patient released on cardiac monitor to home. Later that night, patient had increased heart rate again - 160''s - while in bed. Admitted to hospital. |
|
| VAERS ID: |
912669 (history) |
| Form: |
Version 2.0 |
| Age: |
58.0 |
| Sex: |
Female |
| Location: |
Georgia |
| Vaccinated: | 2020-12-22 |
| Onset: | 2020-12-23 |
| 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 |
EL0140 / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Catheterisation cardiac normal,
Chest pain,
Computerised tomogram normal,
Dyspnoea,
Electrocardiogram normal,
Troponin normal
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)
Life Threatening? No
Birth Defect? Yes
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: None
Current Illness: None
Preexisting Conditions: Migraines, Arthiritis
Allergies: Flexril
Diagnostic Lab Data: EKG, Troponins, CT, Cardiac Cath - all negative, 12/23/2020
CDC Split Type:
Write-up: Chest pain, short of breath. Morphine, sublingual Nitro, IV Nitro drip & Heparin drip |
|
| VAERS ID: |
912701 (history) |
| Form: |
Version 2.0 |
| Age: |
82.0 |
| Sex: |
Male |
| Location: |
Arizona |
| Vaccinated: | 2020-12-18 |
| Onset: | 2020-12-23 |
| Days after vaccination: | 5 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-29 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EK5730*CSU-C19 / 1 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Angiogram abnormal,
Aspartate aminotransferase increased,
Blood albumin increased,
Blood alkaline phosphatase increased,
Blood creatinine increased,
Blood glucose increased,
Blood urea increased,
COVID-19 pneumonia,
Carbon dioxide decreased,
Cardiopulmonary failure,
Cognitive disorder,
Dyspnoea,
Eosinophil count decreased,
Glomerular filtration rate decreased,
Hypernatraemia,
Hypoxia,
Lymphocyte count decreased,
Neutrophil count increased,
Protein total increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (narrow), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haematopoietic leukopenia (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Biliary system related investigations, signs and symptoms (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow), Noninfectious myocarditis/pericarditis (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? Yes, 6 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: - glipizide 2.5 mg/d - metformin ER 2000 mg/d - insulin sliding scale - lisinopril 10 mg/d - amlodipine 2.5 mg/d - furosemide 20 mg/d - Na Bicarb 650 mg TID added 5/23 by nephrology - atorvastatin 20 mg/d - ASA 81 mg/d - levoth
Current Illness:
Preexisting Conditions: CKD 3 HNT Dementia DMII Hypothyroidism
Allergies: none
Diagnostic Lab Data:
CDC Split Type:
Write-up: Hospitalization 12/26 for Covid PNA |
|
| VAERS ID: |
912713 (history) |
| Form: |
Version 2.0 |
| Age: |
70.0 |
| Sex: |
Female |
| Location: |
California |
| 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 |
EH9899 / UNK |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Asthenia,
Ataxia,
Consciousness fluctuating,
Dizziness,
Palpitations
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (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? No
Hospitalized? Yes, 1 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Hydrocodone/acetaminophen (nausea/vomiting)
Diagnostic Lab Data:
CDC Split Type:
Write-up: Patient reported dizziness, weakness, in and out of consciousness, palpitation and ataxia approximately 10 minutes after vaccination. Sent to ED and diagnosed with potential cerebral mass. Palpitations has occurred more frequently in the last 4 months when she ran out of metoprolol for the treatment of SVT since her PMH retired and she has not established new care yet. Dizziness, palpitations and ataxia resolved by next AM. Follow up with outpatient Neuro and cardiology. Given prescription for metoprolol XL 75 daily. |
|
| VAERS ID: |
912766 (history) |
| Form: |
Version 2.0 |
| Age: |
27.0 |
| Sex: |
Male |
| Location: |
Kentucky |
| 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 |
025J20A / 1 |
LA / IM |
Administered by: Public Purchased by: ?
Symptoms: Arrhythmia,
Atrial fibrillation,
Cardiac flutter,
Cardiac telemetry,
Dizziness,
Hyperhidrosis,
Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Tachyarrhythmia terms, nonspecific (narrow), Vestibular disorders (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, 2 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: OTC zinc, magnesium, and MVI
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: The client reports that he was hooked to telemetry. Any other tests/labs are unknown.
CDC Split Type:
Write-up: Client was vaccinated approx 10:00am at the Health Dept. Client left after 15min without incident. Client went to report to work and began feeling nauseated, dizzy, and feeling as if was going to faint. Client returned to Health Department approx 12:30. Client was diaphoretic, HR was 140bpm, and BP was 178/120. Client was given 50mg/20mL of diphenhydramine PO and EMS was called and client taken to local ER. Client remained A+Ox3 at time of EMS transport. Spoke with client evening of 12/28/2020. He reports he was transferred to another facility and was told was in a-fib. He reports that he is feeling much better but heart still fluttering. Spoke with client afternoon of 12/29/2020. He reports that he is being discharged in a few hours and is being sent home on metoprolol and a baby ASA. He reports they had been working on getting his BP down. He reports that he is feeling better and is going to be scheduled for a heart cath outpatient. He reports that he was initially in a-fib, then a-flutter, and then arrhythmia. He reports that he has been seen by Dr. a Cardiologist, while hospitalized. |
|
| VAERS ID: |
912785 (history) |
| Form: |
Version 2.0 |
| Age: |
38.0 |
| Sex: |
Female |
| Location: |
California |
| 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 |
EJ1685 / 1 |
UN / IM |
Administered by: Private Purchased by: ?
Symptoms: Condition aggravated,
Dyspnoea,
Hypertension,
Hypertensive urgency,
Pharyngeal swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Hypertension (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: unknown
Current Illness: unknown
Preexisting Conditions: asthma, HTN
Allergies: Sulfa drugs
Diagnostic Lab Data:
CDC Split Type:
Write-up: Monitored x 15 min per guidelines. Began to experience SOB and throat swelling, after which pt presented to the ED for tx, dx acute hypertensive urgency with severe hypertension. |
|
| VAERS ID: |
912826 (history) |
| Form: |
Version 2.0 |
| Age: |
57.0 |
| Sex: |
Female |
| Location: |
California |
| 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 |
EJ1685 / 1 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Cough,
Pruritus
SMQs:, Anaphylactic reaction (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: unknown
Current Illness: unknown
Preexisting Conditions: asthma, HTN
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:
Write-up: Itching, cough. Given benadryl 50mg and epinephrine 0.3 in vaccine clinic, and taken to ED for further tx. |
|
| VAERS ID: |
912834 (history) |
| Form: |
Version 2.0 |
| Age: |
24.0 |
| Sex: |
Female |
| Location: |
Virginia |
| 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 |
LA / SYR |
Administered by: Other Purchased by: ?
Symptoms: Electrocardiogram abnormal,
Heart rate increased,
Hypoaesthesia,
Miosis,
Mydriasis,
Neurological examination,
Peripheral coldness,
Pyrexia,
Tachyarrhythmia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (broad), Sexual dysfunction (broad), Noninfectious myocarditis/pericarditis (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Amoxicillin
Diagnostic Lab Data: EKG Showed heart was tachycardic and irregular. Raised fever-99.5. Neurological test to explain dilated and constricted pupils.
CDC Split Type:
Write-up: With five minutes of vaccine Increased heart rate shot up to 198 bpm. Regular resting heart rate for me is in the 50s. Left pupil dilated completely, right people constricted to pin size. Extremities went numb and ice cold. Went to emergency room Per request of EMTs at vaccination center. Was given high-dose Benadryl and Saline IV. Heart rate return to normal and all other symptoms disappeared after treatment. |
|
| VAERS ID: |
912883 (history) |
| Form: |
Version 2.0 |
| Age: |
41.0 |
| Sex: |
Male |
| Location: |
Missouri |
| Vaccinated: | 2020-12-01 |
| Onset: | 2020-12-23 |
| Days after vaccination: | 22 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-29 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
- / 1 |
LA / SYR |
Administered by: Private Purchased by: ?
Symptoms: Dyspnoea,
Joint stiffness
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Arthritis (broad), Tendinopathies and ligament disorders (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: -Seroquel 1-300 mg -Gabapentin 2-300 mg -Depakote 3-250 mg -Escitalopram (Lexapro) 10 mg -Copaxone 1-40 mg MWF Vitamin B6 1-100 mg Vitamin D3 3-1000 IU
Current Illness:
Preexisting Conditions: Multiple Sclerosis, Bipolar
Allergies: Zyprexa, Trazadone
Diagnostic Lab Data:
CDC Split Type:
Write-up: Difficulty catching my breath, stiff joints in legs |
|
| VAERS ID: |
912930 (history) |
| Form: |
Version 2.0 |
| Age: |
29.0 |
| Sex: |
Female |
| Location: |
Minnesota |
| Vaccinated: | 2020-12-29 |
| Onset: | 2020-12-29 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-29 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
037K20A / 1 |
RA / IM |
Administered by: Senior Living Purchased by: ?
Symptoms: Feeling abnormal,
Muscular weakness,
Nausea,
Syncope,
Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Migraines
Preexisting Conditions: Migraines
Allergies: Ibuprofen
Diagnostic Lab Data: Blood pressure estimated at 143/80 (12/29/20 @ 2:40 pm)
CDC Split Type:
Write-up: Patient was monitored for $g15 minutes after vaccination. Patient told a nurse that her knees felt weak. Patient then fainted and was laying on the floor when i arrived. Patient reported she felt like she was "floating" and she did not want to "fall". She was also nausea and wanted to vomit and did not end up vomiting anything up. Patient fainted several more times. Her BP was around 143/80 and unsure about the pulse. Patient then become unresponsive for 20-30 seconds. |
|
