|
| VAERS ID: |
914798 (history) |
| Form: |
Version 2.0 |
| Age: |
54.0 |
| Sex: |
Female |
| Location: |
California |
| Vaccinated: | 2020-12-18 |
| Onset: | 2020-12-20 |
| Days after vaccination: | 2 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-30 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EK5730 / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Bundle branch block right,
Cardiac stress test normal,
Chest X-ray,
Chest pain,
Depressed level of consciousness,
Electrocardiogram abnormal,
Full blood count,
Heart rate decreased,
Hyperhidrosis,
Metabolic function test,
Nausea,
Pallor,
Sinus bradycardia,
Transcutaneous pacing,
Troponin increased
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Disorders of sinus node function (narrow), Conduction defects (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Noninfectious myocarditis/pericarditis (broad)
Life Threatening? Yes
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: Amlodipine 10 mg daily
Current Illness: none
Preexisting Conditions: Hypertension
Allergies: No known allergies
Diagnostic Lab Data: EKGs, Chest X-rays, Serial Toponin Levels, CBC, CMP, Cariac Stress test
CDC Split Type:
Write-up: On Dec. 20, 2020 around 11:30 PM, 2 days after patient received her COVID-19 vaccination, she was found on the bathroom floor , obtunded, very pale, diaphoretic, nauseous, and complaining of severe chest pain. Paramedics was called and patient was transported to the nearest emergency room. According to paramedics, on the way to the ER while patient was in the ambulance,she was noted with a sudden drop in heart rate about 19 beats/minute and have to be given Atropine IV Push, oxygen and was connected to transcutaneous pacing which improves her heart rate. In the ER patient continued to have chest pain and she was given Morphine, Oxygen, Nitroglycerine and Aspirin. IM had an EKG which showed Sinus Bradycardia with a Right Bundle Branch Block. She had serial ekgs, a chest x-ray, laboratory testing which included Troponin. Her first Troponin level came back elevated prompting her hospital admission to Telemetry. Her next 2 Troponin level improved and return to normal range and her chest pain has resolved.. She underwent a Stress Test which came back negative. Patient was admitted for a total of 20 hours in the Telemetry unit with Cardiology consultation before being discharged home last . She was re-evaluated by the cardiologist yesterday which diagnosed her a chest pain of unknown origin. |
|
| VAERS ID: |
914805 (history) |
| Form: |
Version 2.0 |
| Age: |
63.0 |
| Sex: |
Male |
| Location: |
Illinois |
| Vaccinated: | 2020-12-28 |
| Onset: | 2020-12-29 |
| 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 |
EH9899 / 1 |
LA / IM |
Administered by: Other 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: Asa-81mg, Lisinopril 10mg daily, ferrous sulfate-325, MVI with min, zyprexia-20mg, Flomax-0.4, famotidine-20mg, vit C, carbamazepine-250mg bid, Depakote-750mg bid, metformin-1000 bid, sertraline-100 bid, albuterol,buspar-10mg TID, Fibercon-
Current Illness: none
Preexisting Conditions: dysphagia, violent behaviors, depressive disorder, schizophrenia, aspiration, gerd, hyperlipidemia, dipolar, rectal bleeding, HTN
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:
Write-up: RESIDENT CODED AND EXPIRED |
|
| VAERS ID: |
914821 (history) |
| Form: |
Version 2.0 |
| Age: |
42.0 |
| Sex: |
Female |
| Location: |
Idaho |
| 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 (MODERNA)) / MODERNA |
037K20A / 1 |
LA / IM |
Administered by: Military Purchased by: ?
Symptoms: Chest X-ray,
Dizziness,
Echocardiogram,
Electrocardiogram,
Full blood count,
Hypertension,
Metabolic function test,
Myocardial necrosis marker,
Paraesthesia oral,
Peripheral swelling,
Pruritus,
Rash,
Tachycardia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (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), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), 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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: EKG, Cardiac enzymes, CBC, CMP, Chest Xray, Echo pending
CDC Split Type:
Write-up: Rash, Itching and swelling of left arm. Progressed to tachycardia in the 150''s, hypertension 200/114. Tingling of lips, dizziness |
|
| VAERS ID: |
914835 (history) |
| Form: |
Version 2.0 |
| Age: |
51.0 |
| Sex: |
Male |
| Location: |
Unknown |
| Vaccinated: | 2020-12-26 |
| Onset: | 2020-12-28 |
| Days after vaccination: | 2 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-30 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL0142 / 1 |
- / IM |
Administered by: Unknown Purchased by: ?
Symptoms: Dyspnoea,
Hypoxia,
SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (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, ? days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Went to Emergency room on 12/28/20 because he was short of breath. Tested positive for COIVD_19 and was admitted with hypoxia. |
|
| VAERS ID: |
914895 (history) |
| Form: |
Version 2.0 |
| Age: |
78.0 |
| Sex: |
Male |
| Location: |
Nebraska |
| Vaccinated: | 2020-12-28 |
| Onset: | 2020-12-30 |
| Days after vaccination: | 2 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-30 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL1284 / 1 |
LA / IM |
Administered by: Senior Living Purchased by: ?
Symptoms: Death
SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2020-12-30
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: Senna Plus, Loperamide, Ondansetron, Acetaminophen, Mucus & Chest Relief cough syrup, Oystershell Calcium Plus D, Vitamin D3, Escitalopram, Bupropion, Hydrocodone/Acetaminophen, Bisacodyl Suppositories
Current Illness: Alzheimer''s Disease, Encephalopathy, Hypertension,Acute Kidney failure, Urine Retention, Recent UTI
Preexisting Conditions: Alzheimer''s Disease, Encephalopathy, Hypertension
Allergies: No known drug allergies
Diagnostic Lab Data:
CDC Split Type:
Write-up: Injection given on 12/28/20 - no adverse events and no issues yesterday; Death today, 12/30/20, approx.. 2am today (unknown if related - Administrator marked as natural causes) |
|
| VAERS ID: |
914917 (history) |
| Form: |
Version 2.0 |
| Age: |
63.0 |
| Sex: |
Male |
| Location: |
Illinois |
| Vaccinated: | 2020-12-19 |
| Onset: | 2020-12-23 |
| Days after vaccination: | 4 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-30 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EJ1685 / UNK |
- / - |
Administered by: Work Purchased by: ?
Symptoms: Death,
Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2020-12-23
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: Atenolol, Chlorthalidone, Tamsulosin
Current Illness: None
Preexisting Conditions: hypertension
Allergies: None
Diagnostic Lab Data: Death certificate
CDC Split Type:
Write-up: Death by massive heart attack. Pfizer-BioNTech COVID-19 Vaccine EUA |
|
| VAERS ID: |
914961 (history) |
| Form: |
Version 2.0 |
| Age: |
88.0 |
| Sex: |
Female |
| Location: |
Kentucky |
| Vaccinated: | 2020-12-30 |
| Onset: | 2020-12-30 |
| 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 |
EL0142 / 1 |
LA / - |
Administered by: Senior Living Purchased by: ?
Symptoms: Death
SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2020-12-30
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: per nursing home staff over 14 days post covid
Preexisting Conditions:
Allergies: none listed
Diagnostic Lab Data:
CDC Split Type:
Write-up: pt passed away with an hour to hour and 1/2 of receiving vaccine. per nursing home staff they did not expect pt to make it many more days. pt was unresponsive in room when shot was given. per nursing home staff pt was 14 + days post covid |
|
| VAERS ID: |
914994 (history) |
| Form: |
Version 2.0 |
| Age: |
90.0 |
| Sex: |
Female |
| Location: |
Kentucky |
| Vaccinated: | 2020-12-30 |
| Onset: | 2020-12-30 |
| 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 |
EL0142 / 1 |
AR / - |
Administered by: Senior Living Purchased by: ?
Symptoms: Death
SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2020-12-30
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: not known
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: pt was a nursing home pt. pt received first dose of covid vaccine. pt was monitored for 15 minutes after getting shot. staff reported that pt was 15 days post covid. Pt passed away with in 90 minutes of getting vaccine |
|
| VAERS ID: |
915119 (history) |
| Form: |
Version 2.0 |
| Age: |
58.0 |
| Sex: |
Male |
| Location: |
Wyoming |
| Vaccinated: | 2020-12-24 |
| Onset: | 2020-12-29 |
| Days after vaccination: | 5 |
| 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: Private Purchased by: ?
Symptoms: C-reactive protein increased,
COVID-19 pneumonia,
Chest X-ray abnormal,
Computerised tomogram thorax abnormal,
Dyspnoea,
Fibrin D dimer increased,
Hypoxia,
SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haemorrhage laboratory terms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (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: albuterol, Zithromax, Advair
Current Illness: diagnosed with covid19 infection on 12/14/2020, had ulnar nerve and median nerve releases in November, 2020
Preexisting Conditions: tobacco abuse.
Allergies: no known allergies
Diagnostic Lab Data: CT of chest and CXR supported covid19 pneumonia diagnosis with marked elevation in D-dimer, CRP. interestingly SARS-CoV2 rapid antigen was negative on 12/29/2020.
CDC Split Type:
Write-up: The patient had COVID19 infection diagnosed 12/14/2020, and he stated 5 to 10 days after this, he developed shortness of breath. Had vaccine on 12/24/2020. Hypoxic and short of breath with COVID19 pneumonia on 12/29/2020. I do not know if this is an adverse effect or temporally related or if the vaccine activated prior infection. |
|
| VAERS ID: |
915199 (history) |
| Form: |
Version 2.0 |
| Age: |
38.0 |
| Sex: |
Male |
| Location: |
Hawaii |
| Vaccinated: | 2020-12-30 |
| Onset: | 2020-12-30 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-30 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
- / 1 |
LA / IM |
Administered by: Other Purchased by: ?
Symptoms: Electrocardiogram,
Ocular hyperaemia,
Throat irritation
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Glaucoma (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: Lialda for colitis
Current Illness: None
Preexisting Conditions: Colitis
Allergies: None
Diagnostic Lab Data: EKG, pulse ox and blood pressure
CDC Split Type:
Write-up: Itchy throat, red eyes after 30 minutes. EMS on site gave IV Benadryl, epi pen shot and took to ER for monitoring. Vitals were good so he was discharged. |
|
