|
| VAERS ID: |
913733 (history) |
| Form: |
Version 2.0 |
| Age: |
85.0 |
| Sex: |
Female |
| Location: |
Pennsylvania |
| Vaccinated: | 2020-12-29 |
| Onset: | 2020-12-29 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-30 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
- / UNK |
- / - |
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: My grandmother died a few hours after receiving the moderna covid vaccine booster 1. While I don?t expect that the events are related, the treating hospital did not acknowledge this and I wanted to be sure a report was made. |
|
| VAERS ID: |
913764 (history) |
| Form: |
Version 2.0 |
| Age: |
47.0 |
| Sex: |
Male |
| Location: |
New Mexico |
| Vaccinated: | 2020-12-20 |
| Onset: | 2020-12-21 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-30 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Chest pain,
Condition aggravated,
Coronary artery disease,
Headache,
Laboratory test,
Migraine
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Other ischaemic heart disease (narrow)
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: Vit. D3, Magnesum, Acetaminophen, B12, Rosuvastatin, Trazodone, fatomadien, alloturinol, propranolol, losartan
Current Illness: migranes, diabetes hypertension
Preexisting Conditions: Lower back pain, arthritis- both knees, ankles, shoulders and thumbs, gout
Allergies: lisinopril
Diagnostic Lab Data: labs
CDC Split Type: vsafe
Write-up: About 3 am after the injection I woke up with severe chest pains and headache and went to the ER. I was admitted for 2 days and was released with a prescription of Isosorb Monoer, Metroprol, aspirin which is used as a blood thinner. The diagnosis and prognosis was severe migranes and cardioartery disease. |
|
| VAERS ID: |
913807 (history) |
| Form: |
Version 2.0 |
| Age: |
49.0 |
| Sex: |
Female |
| Location: |
Washington |
| Vaccinated: | 2020-12-20 |
| Onset: | 2020-12-20 |
| 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 |
EJ1685 / UNK |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Hypoaesthesia,
Paraesthesia oral,
Tongue dry
SMQs:, Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Dehydration (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? No
Hospitalized? Yes, 1 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: No
Current Illness: No
Preexisting Conditions: High blood pressure Arthritis.
Allergies: Lisinopril.
Diagnostic Lab Data:
CDC Split Type: vsafe
Write-up: Left side of my face went numb. 5 minutes later tongue was dry and tingly. Went back to place of work and went to monitoring room. Went to ER to be checked out. Got better over that day. I was admitted the same day and discharged the next day. |
|
| VAERS ID: |
913854 (history) |
| Form: |
Version 2.0 |
| Age: |
49.0 |
| Sex: |
Female |
| Location: |
California |
| Vaccinated: | 2020-12-29 |
| Onset: | 2020-12-29 |
| 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 |
EJ1685 / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Anxiety,
Dyspnoea,
Flushing,
Hyperhidrosis,
Hypertension,
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), 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: Pt later reported new diagnosis of lupus
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:
Write-up: anxiety, tachycardia, flushing, diaphoresis, HTN, SOB |
|
| VAERS ID: |
913866 (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: |
2020-12-30 |
| 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,
Localised oedema,
Pharyngeal swelling,
Pruritus,
Rash macular,
Skin burning sensation,
Throat irritation,
Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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? Yes, ? days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prenatal Multivitamin
Current Illness: NA
Preexisting Conditions:
Allergies: Amoxicillin - Hives Iodinated Casein - Anaphylaxis Oxycodone - Hives Penicillins - Hives Roxicodone - Hives
Diagnostic Lab Data:
CDC Split Type:
Write-up: Patient administered Pfizer-BioNtech vaccine, dose #1 in series at 810AM, without notable concerns for 10 minutes. At 10 minutes post vaccination, patient developed itching and some blotching, throat becoming scratchy. No known allergies to components listed in vaccine, though does have a listed allergy to contrast dye, does not carry an epi-pen. Patient was walked to urgent/emergency care in the clinic, where she was seen immediately. Patient was given diphenhydramine 25 mg IV, pantoprazole 40 mg IV, with mild uticaria continuing. Patient notes she feels her ''back is on fire''. Patient was then given methylprednisolone 125 mg IV. At this time, no SOB is noted, uticaria is still present. 0930 patient reports swelling in throat and respiratory difficulties at this time with visible edema in the neck. 0.3 mg Epinephrine given at 0935, epinephrine drip and racemic epinephrine neb given. 1006 Patient on epinephrine drip 2.5 mics/hour. Patient transferred to Medical Center ICU, where she remains at the time of this report. |
|
| VAERS ID: |
914137 (history) |
| Form: |
Version 2.0 |
| Age: |
52.0 |
| Sex: |
Female |
| Location: |
Maryland |
| Vaccinated: | 2020-12-27 |
| Onset: | 2020-12-28 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-30 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
025J20A / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Impaired driving ability,
Impaired work ability,
Injected limb mobility decreased,
Pain
SMQs:
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: minasterin oral contraceptive
Current Illness: none
Preexisting Conditions: none
Allergies: systane eye drops (Restore ok)
Diagnostic Lab Data: none
CDC Split Type:
Write-up: decreased range of motion in vaccinated arm: unable to raise left arm above shoulder x 72 hours now due to pain. no associated numbness or swelling. I am a surgeon and this impacts my work and driving. I would not have been able to operate during these last 3 days and while the pain is better 72hrs later, my arm is still out of commission. I think we need to inform healthcare providers who perform procedures that they may want to schedule the vaccine when no planned procedures for at least 72 hrs. Due to this issue I will be unable to proceed with the second dose, unless I can take it a week later than the scheduled January 24, 2021. It is taking too long to regain full function of the arm but i expect it will be back to normal as it is better today 72 hrs later. |
|
| VAERS ID: |
914139 (history) |
| Form: |
Version 2.0 |
| Age: |
46.0 |
| Sex: |
Female |
| Location: |
Hawaii |
| Vaccinated: | 2020-12-23 |
| Onset: | 2020-12-23 |
| 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 |
EL1284 / 1 |
UN / IM |
Administered by: Private Purchased by: ?
Symptoms: Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Sexual dysfunction (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, 1 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Facial numbness radiating down left side of neck to left arm, elbow and chest. Went to ED, admitted for observation overnight. |
|
| VAERS ID: |
914280 (history) |
| Form: |
Version 2.0 |
| Age: |
63.0 |
| Sex: |
Female |
| Location: |
Illinois |
| Vaccinated: | 2020-12-17 |
| Onset: | 2020-12-26 |
| Days after vaccination: | 9 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-30 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EK5730 / 1 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Anosmia,
Blood magnesium,
Brain natriuretic peptide,
C-reactive protein,
Chest X-ray,
Chills,
Cough,
Diarrhoea,
Dyspnoea,
Electrocardiogram normal,
Fibrin D dimer,
Full blood count,
Influenza virus test negative,
Metabolic function test,
Nausea,
Paranasal sinus hypersecretion,
Pyrexia,
Red blood cell sedimentation rate,
SARS-CoV-2 test positive,
Troponin T
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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? 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: aspirin 81mg, nitro 0.4 sublingual, hydrochlorothiazide 25mg, repatha 120mg, plavix 75mg, rotonix, torsemide 5mg, zetia 10mg, zoloft 100mg, bystolic 5mg, synthroid 100mcg, telmisartan 80mg, allopurinol 100mg,
Current Illness:
Preexisting Conditions: hypothyroidism, CAD, HTN, Hyperlipidemia, GERD, gout, osa,
Allergies: Codeine, erythromycin, augmentin
Diagnostic Lab Data: COVID swab - positive EKG, - normal Flu Swabs - negative CBC, CMP, Magnesium, CRP, LFH, ESR, BNP, Tropon T, D-Dimer, Chest xray
CDC Split Type:
Write-up: Patient presented to the ER on 12/26/2020 with complaints of fever, chills and SOB for about 3 days. Stated it was a gradual onset and has been intermittent. Also reported some nausea and chronic loose stools, mild loss of smell and sinus drainage, non productive cough. Discharged to observation and then home on 12/27/2020. Patient readmitted to hospital on 12/30/2020. |
|
| VAERS ID: |
914309 (history) |
| Form: |
Version 2.0 |
| Age: |
46.0 |
| Sex: |
Female |
| Location: |
Arizona |
| Vaccinated: | 2020-12-29 |
| Onset: | 2020-12-29 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-30 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
011J20A / 1 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Dry throat,
Flushing,
Heart rate increased,
Obstructive airways disorder,
Oropharyngeal pain
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (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: Excedrin Migraine at 9:00 PM on 12/28/2020
Current Illness: None
Preexisting Conditions: History of allergies and anaphylaxis to raw produce
Allergies: Anaphylaxis to bananas, avocados and raw produce
Diagnostic Lab Data: None
CDC Split Type:
Write-up: Within 3 minutes of vaccination patient became fully flushed head and neck, with rapid heart rate (112), and feeling like her airways were tightening.. Nurse immediately called for response, administered Epipen, when response arrived applied oxygen and transported to ED. Solumedrol 125 mg, Bendadryl 25 mg, and Famotidine 20 mg, she responded well and was released home with Rx Prednisone 40 mg x 3 days. Only residual effect was a dry/sore throat. |
|
| VAERS ID: |
914392 (history) |
| Form: |
Version 2.0 |
| Age: |
59.0 |
| Sex: |
Female |
| Location: |
Ohio |
| Vaccinated: | 2020-12-23 |
| Onset: | 2020-12-30 |
| Days after vaccination: | 7 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-30 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
011J20A / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Angioedema,
Asymptomatic COVID-19,
Blood creatine phosphokinase normal,
Enlarged uvula,
Erythema,
Exposure to SARS-CoV-2,
Feeling hot,
Full blood count normal,
Lip swelling,
Liver function test normal,
Metabolic function test normal,
Pain in extremity,
Quarantine,
Rash,
Rash erythematous,
SARS-CoV-2 test positive,
Swelling face,
Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)
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: Metformin, lisinopril. HCTZ, zetia, atorvastatin, KCL, baby aspirin, vitamin D, melatonin, B12, Nexium, vitamin E, ceterizine
Current Illness: Was covid negative 12/23. Tested covid positive 12/26. No symptoms of covid. (Husband has work exposure and had tested positive 12/23) we have quarentined since 12/23
Preexisting Conditions: diabetes, hypertension, elevated cholesterol, elevated liver enzymes, GERD
Allergies: None
Diagnostic Lab Data: 9:35am took Benadryl 50mg po, went to ED (arrived about 10am). had improved swelling and rash at 10:am. Physician reported uvula swollen. Received decadron 8mg po, Racemic epi nebulizer, IV fluid Lactated ringers. Labwork CBC, BMP , CK, Liver panel reported to me "normal". Improved and dismissed from ED 12noon 12/30.
CDC Split Type:
Write-up: 12/30 9:30 am developed angioedema. Swelling of face, lips, tight throat. Also had bright red rash over body trunk and arms. Both palms were red, hot and painful. |
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