|
| VAERS ID: |
912954 (history) |
| Form: |
Version 2.0 |
| Age: |
102.0 |
| Sex: |
Female |
| Location: |
North Dakota |
| 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 |
025J20-2A / 1 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Activated partial thromboplastin time normal,
Adjusted calcium,
Alanine aminotransferase normal,
Anion gap normal,
Aortic valve calcification,
Arteriosclerosis coronary artery,
Aspartate aminotransferase normal,
Atelectasis,
Atrial enlargement,
Basophil count normal,
Basophil percentage,
Blood albumin normal,
Blood alkaline phosphatase normal,
Blood bilirubin increased,
Blood calcium,
Blood chloride normal,
Blood creatinine normal,
Blood glucose normal,
Blood lactic acid,
Blood potassium normal,
Blood sodium normal,
Blood urea nitrogen/creatinine ratio,
Blood urea normal,
Brain natriuretic peptide increased,
C-reactive protein increased,
Carbon dioxide decreased,
Cardiac failure congestive,
Cardioactive drug level,
Cardiomegaly,
Computerised tomogram thorax abnormal,
Cough,
Eosinophil count normal,
Eosinophil percentage,
Fibrin D dimer,
Fluid overload,
Glomerular filtration rate normal,
Haematocrit decreased,
Haemoglobin decreased,
International normalised ratio increased,
Intervertebral disc degeneration,
Lymphocyte count decreased,
Lymphocyte percentage decreased,
Mean cell haemoglobin concentration normal,
Mean cell haemoglobin increased,
Mean cell volume increased,
Mean platelet volume increased,
Monocyte count normal,
Monocyte percentage,
Neutrophil count normal,
Neutrophil percentage increased,
Osteoarthritis,
Platelet count normal,
Pleural effusion,
Protein total normal,
Prothrombin time prolonged,
Pulmonary oedema,
Pyrexia,
Red blood cell count decreased,
Red cell distribution width increased,
SARS-CoV-2 test positive,
Serum ferritin increased,
Spinal disorder,
Staphylococcus test negative,
Tachycardia,
Tachypnoea,
Troponin,
White blood cell count normal
SMQs:, Cardiac failure (narrow), Liver related investigations, signs and symptoms (narrow), Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Biliary system related investigations, signs and symptoms (narrow), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Other ischaemic heart disease (narrow), Chronic kidney disease (broad), Arthritis (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (broad), Dehydration (broad), 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, 1 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: tylenol aspirin Atorvastatin B12 Folate Diltiazem Docusate Digoxin Furosemide Potassium Chloride Levothyroxine Lisinopril Protonix Vitamin D3 Warfarin Polyethylene Glycol
Current Illness: COVID-19 (Diagnosed 10/26/20)
Preexisting Conditions: Diabetes Type II Atrial Fibrillation Hypothyroidism CHF Hypertension Osteoporosis Anemia Cerebrovascular disease Aphasia
Allergies: ibuprofen Lactose
Diagnostic Lab Data: Troponin First 0.071, Second 0.054 BNP-398 Digoxin 1.2 SARS -COV-2 Detected MRSA not detected CTA- FINDINGS: Mild motion artifact somewhat limits the evaluation. No definite pulmonary emboli. ?Mild to moderate diffuse interstitial prominence suggesting edema. ?Small bilateral effusions with mild probable atelectasis in the bases. ?Mild to moderate cardiomegaly with biatrial enlargement. Aortic valvular and coronary artery calcification. ?No definite pathologic lymphadenopathy. Mild to moderate spinal curvature. ?Degenerative changes of the spine and both shoulders. ? IMPRESSION: 1. ?Mild to moderate cardiomegaly with biatrial enlargement. ?Mild to moderate diffuse interstitial prominence suggesting edema with small bilateral effusions. ?Findings suggest an element of fluid overload/congestive failure. 2. ?Additional nonacute/chronic findings, as detailed above. 3. ?No definite pulmonary emboli. Results for Patient as of 12/29/2020 17:25 12/29/2020 08:19 WBC: 8.3 RBC: 3.09 (L) Hemoglobin: 10.3 (L) Hematocrit: 31.0 (L) MCV: 100.3 (H) MCH: 33.3 (H) MCHC: 33.2 RDW-CV: 15.4 RDW-SD: 57.2 (H) Platelet Count: 153 MPV: 11.5 Seg Neut Absolute: 6.9 Lymphocytes Absolute: 0.7 (L) Monocytes Absolute: 0.4 Eosinophils Absolute: 0.2 Basophil Absolute: 0.1 Neutrophils Percent: 83.5 Neutrophils Abs. (Segs and Bands): 6,900 Lymphocytes Percent: 8.8 (L) Monocytes Percent: 4.6 Eosinophils Percent: 2.1 Basophil Percent: 0.8 Glucose: 130 (H) Sodium: 138 Potassium: 4.0 Chloride: 103 CO2: 21 Anion Gap with K: 18 BUN: 17 Creatinine: 0.84 BUN/Creatinine Ratio: 20.2 Calcium: 8.8 Corrected Calcium: 9.0 Bilirubin Total: 1.1 Alkaline Phosphatase: 82 ALT - SGPT: 19 AST - SGOT: 25 Protein Total: 6.5 Albumin: 3.8 Ferritin: 168 CRP: 3.2 Lactic Acid: 1.3 eGFR African American: 75 eGFR Non-African American: 62 Protime: 17.5 (H) INR: 1.5 (H) APTT: 30.7 D-Dimer: 1.19 (H)
CDC Split Type:
Write-up: Fever, coughing, tachypnea, tachycardia |
|
| VAERS ID: |
912957 (history) |
| Form: |
Version 2.0 |
| Age: |
42.0 |
| Sex: |
Female |
| Location: |
Oklahoma |
| 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 |
025J20-2A / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Anxiety,
Chest pain,
Dysphagia,
Dyspnoea,
Oropharyngeal discomfort,
Pruritus
SMQs:, Anaphylactic reaction (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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: Zrytec 10 mg; estradiol 1mg; atrovent; singular 10mg; ventalin Advair; Lexapro 20mg; melatonin 6 mg; vitamin D; Quercitin, Vitamin C; Vitamin B1; Zinc; ASA 81 mg; daily vitamin
Current Illness: None
Preexisting Conditions: Mast Cell Activation; Asthma
Allergies: Cats; Pork; Dilaudid; Nubain
Diagnostic Lab Data: unknown at this time
CDC Split Type:
Write-up: Received vaccine at 13 15. At 1351 c/o mild chest pain. 1353 c/o throat fullness and anxiety; 1354 bp 148/81 HR 99 O2 sat 100% c/o difficulty swallowing, SOB and itching. Rapid response called. Benadryl 50 mg IVP given at 1355. 1356 Solumedrol 125mg given IV; 1357 Epinephrine given; 1358 Pepcid 20 mg given. 1400 Normal saline 250 mg IV; 1415 transported by ambulance to local ER. In waiting area in local ER no attention. Came back to Hospital and admitted to observation |
|
| VAERS ID: |
913061 (history) |
| Form: |
Version 2.0 |
| Age: |
47.0 |
| Sex: |
Female |
| Location: |
Delaware |
| 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 |
EJ1686 / 1 |
LA / SYR |
Administered by: Work Purchased by: ?
Symptoms: Chest discomfort,
Cough,
Dizziness,
Dysphagia,
Dyspnoea,
Fatigue,
Headache,
Heart rate increased,
Laboratory test,
Nausea,
Pharyngeal swelling
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic 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), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (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? Yes
Hospitalized? No
Previous Vaccinations: FLU VACCINE - COUGH AND SOB
Other Medications: NONE
Current Illness: ASTHMA
Preexisting Conditions: ASTHMA MIGRIANE
Allergies: SULFA EGG FEATHER MOLD PINE
Diagnostic Lab Data: LABS AND VITAL MONITORING.
CDC Split Type:
Write-up: 10 MINUTES FOLLOWING VACCINE - SOB, COUGH, TIGHTNESS IN CHEST, THRAOT SWELLING, DIFFICULTY SWALLOWING, LIGHT HEADEDNESS, AND ELEVATED HEART RATE. ORAL AND IM BENADRYL ADMINISTERED, 2 DOSE OF EPINEPHRINE, 2 NEB TREATMENTS, O2 PLACED. 911 CALLED AND TRANSPORTED TO EMERGENCY FOR FURTHER TREATMENT AND MONITORING. AT HOSPITAL IV STEROID ADMINISTERED. SYMPTOMS SUBSIDED WITH SECOND DOSE OF EPINEPHRINE, HOWEVER RETURNED 3 HOURS LATER AND ANOTHER DOSE OF BENADRYL ADMINISTERED. ELEVATED HEART RATE CONTINUED AND IV FLUIDS ADMINISTERED TO ATTEMPT IN BRINGING DOWN HEART RATE. IV FLUIDS WERE NOT EFFECTIVE. HEART RATE (118-120) REMAINED ELEVATED INTO THE OVERNIGHT HOURS AND SUBSIDED AROUND 1:30A ON 12/29/2020. CONTINUED HEADACHE, NAUSEA ONSET, FATIGUE, DIFFICULTY SWALLOWING AND COUGH ON 12/29/2020. |
|
| VAERS ID: |
913106 (history) |
| Form: |
Version 2.0 |
| Age: |
82.0 |
| Sex: |
Female |
| Location: |
New York |
| Vaccinated: | 2020-12-26 |
| Onset: | 2020-12-27 |
| 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: Senior Living Purchased by: ?
Symptoms: Blood pressure increased,
Breath sounds abnormal,
Chills,
Pneumonia,
Tremor,
Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (narrow), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (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: Amlodipine 2.5mg, aspirin 81mg, atorvastatin 10mg, bacid tablet, namenda 5mg, keppra 500mg, meclizine 12.5, mirtazapinr 15mg, tylenol 325
Current Illness:
Preexisting Conditions: Alzheimers, hyperlipidemia, thrombocytopenia, TIA, major depressive disorder
Allergies: None
Diagnostic Lab Data: BP 213/159; 92% oxygen saturation on room air
CDC Split Type:
Write-up: The morning after getting vaccine, patient had high BP 213/159, 92% on room air, shaking, chills, LCTAB with diminishment at bases, emesis. Admitted to hospital for pneumonia. |
|
| VAERS ID: |
913143 (history) |
| Form: |
Version 2.0 |
| Age: |
84.0 |
| Sex: |
Female |
| Location: |
Texas |
| 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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL0140 / 1 |
LA / IM |
Administered by: Senior Living Purchased by: ?
Symptoms: Death
SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2020-12-29
Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Gabapentin 100mg, Memantine 10mg
Current Illness:
Preexisting Conditions: dementia, aphasia, type 2 DM, iron deficiency, asthenia, osteoporosis, polyneuropathy, anxiety, MDD
Allergies: codeine, phenobarbital, penicillin
Diagnostic Lab Data:
CDC Split Type:
Write-up: Vaccine administered with no immediate adverse reaction at 11:29am. Vaccine screening questions were completed and resident was not feeling sick and temperature was 98F. At approximately 1:30pm the resident passed away. |
|
| VAERS ID: |
913218 (history) |
| Form: |
Version 2.0 |
| Age: |
25.0 |
| Sex: |
Female |
| Location: |
Texas |
| Vaccinated: | 2020-12-27 |
| Onset: | 2020-12-27 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-30 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
037K20A / 1 |
LA / IM |
Administered by: Pharmacy Purchased by: ?
Symptoms: Dizziness,
Headache,
Nausea,
Peripheral swelling
SMQs:, Cardiac failure (broad), Acute pancreatitis (broad), Angioedema (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), 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? Yes, 2 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen 1000mg and 25mg diphenhydramine
Current Illness:
Preexisting Conditions: lupus, asthma, ulcerative colitis
Allergies: none
Diagnostic Lab Data:
CDC Split Type:
Write-up: headache, nausea, light headed, swelling of the hands Patient was given 1000mg of acetaminophen and 25mg diphenhydramine. Patient was monitored for 60 minutes. |
|
| VAERS ID: |
913238 (history) |
| Form: |
Version 2.0 |
| Age: |
52.0 |
| Sex: |
Female |
| Location: |
California |
| Vaccinated: | 2020-12-28 |
| Onset: | 2020-12-28 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-30 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EH 9899 03/212 / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Asthenia,
Cough,
Dry throat,
Hypertension,
Hyporesponsive to stimuli,
Lethargy,
Retching,
Tachycardia,
Throat irritation
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), 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), Hypertension (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (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: unknown
Current Illness: unknown
Preexisting Conditions: brain tumor but treatment outcome unknown to this examiner
Allergies: urticaria when exposed to certain foods or meds, since treatment for brain tumor
Diagnostic Lab Data: BP was 183/99 at max while in clinic, pulse ranged from 150-180 O2 sat was 100% on room air, lungs were clear, no stridor, Cor: fast RRR. Rapid Response code was called, pt. taken to our E.D. on gurney, she was given I.M.. Epinephrine, I,V. Benedryl, steroids and fluids and was stabilized while there.
CDC Split Type:
Write-up: Pt. developed tachycardia, hypertension and felt weak with decreased verbal responsiveness, alert but lethargic. She complained of dry throat, took a sip of water then began persistent coughing and wretching also C/O itching of her throat. She denied difficulty breathing, there were no cutaneous signs of edema, tongue enlargement, etc. |
|
| VAERS ID: |
913239 (history) |
| Form: |
Version 2.0 |
| Age: |
45.0 |
| Sex: |
Female |
| Location: |
California |
| Vaccinated: | 2020-12-28 |
| Onset: | 2020-12-28 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-30 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EH9899 03/2021 / 1 |
AR / IM |
Administered by: Private Purchased by: ?
Symptoms: Anaphylactic reaction,
Asthenia,
Chest pain,
Heart rate increased,
Oesophageal pain,
Palpitations
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), 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: unknown
Current Illness: denied
Preexisting Conditions: unknown
Allergies: denied hx of allergy or anaphylaxis
Diagnostic Lab Data: Pulse was measured at 170-180 range, very regular, no EKG machine was available so an SVT was considered possibly triggered by stress as another staff member was developing anaphylaxis near by. Pt. was calm and denied anxiety except with regard to her palpitations and mid sternal burning. O2 sat was 100% on room air, no respiratory, cutaneous or G.I. symptoms at the time of onset. Since pulse and symptoms did not diminish over the next 15 minutes we transported her to our E.R. where she subsequently also underwent treatment for anaphylaxis with Epinephrine, benedryl, steroids and multiple liters of fluid to which she responded and stabilized.
CDC Split Type:
Write-up: Pt. began to feel weak with palpitations about 8-10 minutes after vaccination, her pulse was extremely fast, she then began to complain of lower mid-esophageal burning |
|
| VAERS ID: |
913445 (history) |
| Form: |
Version 2.0 |
| Age: |
24.0 |
| Sex: |
Female |
| Location: |
Unknown |
| Vaccinated: | 2020-12-27 |
| Onset: | 2020-12-27 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-30 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
- / 1 |
UN / IM |
Administered by: Private Purchased by: ?
Symptoms: Anaphylactic reaction,
Chest discomfort,
Intensive care,
Lip swelling,
Pruritus,
Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anaphylactic/anaphylactoid shock conditions (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: Influenza vaccine = hives
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Pt reports having hives to the influenza vaccine
Diagnostic Lab Data:
CDC Split Type:
Write-up: Pt developed anaphylaxis, was given IM Benadryl, and was sent to the ED. Pt spent 1 night in the hospital, went home, and has come back and is in the ICU. Pt had hives, itching, chest tightness, swollen lips. |
|
| VAERS ID: |
913560 (history) |
| Form: |
Version 2.0 |
| Age: |
53.0 |
| Sex: |
Female |
| Location: |
Illinois |
| Vaccinated: | 2020-12-18 |
| Onset: | 2020-12-18 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-30 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
PAA 156051 / 1 |
UN / IM |
Administered by: Private Purchased by: ?
Symptoms: Chest discomfort,
Electrocardiogram normal,
Myocardial necrosis marker normal
SMQs:, Anaphylactic reaction (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:
Other Medications: Sertraline 100 mg twice daily
Current Illness: None
Preexisting Conditions: Lupus, RA
Allergies: PCN, Toradol, Bees, Biaxin
Diagnostic Lab Data: EKG, cardiac enzymes. All negative for cardiovascular event. 12/18/20.
CDC Split Type:
Write-up: Approximately 15 minutes after IM injection, patient developed chest tightness. Patient was taken to the Emergency Department for treatment. Was given sublingual nitroglycerin and subsequently admitted to the hospital for observation. Patient discharged home the following morning in good condition. |
|
