|
| VAERS ID: |
915161 (history) |
| Form: |
Version 2.0 |
| Age: |
34.0 |
| Sex: |
Female |
| Location: |
Oregon |
| Vaccinated: | 2020-12-18 |
| Onset: | 2020-12-19 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-31 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EH9899 / 1 |
- / - |
Administered by: Private Purchased by: ?
Symptoms: Breast pain,
Breast tenderness,
Headache,
Lymph node palpable,
Lymphadenopathy,
Musculoskeletal stiffness,
Pain,
Pain in extremity,
Tenderness
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Lipodystrophy (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), 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? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2020506596
Write-up: my left arm and breast were tender with some mild body aches and low grade headache/Arm soreness; my left arm and breast were tender with some mild body aches and low grade headache/ left breast was increasingly painful with swollen palpable lymph nodes; my left arm and breast were tender with some mild body aches and low grade headache/ left breast was increasingly painful with swollen palpable lymph nodes; my left arm and breast were tender with some mild body aches and low grade headache/ left breast was increasingly painful with swollen palpable lymph nodes; my left arm and breast were tender with some mild body aches and low grade headache; body soreness and stiffness; This is a spontaneous report from a contactable healthcare professional. A 34-year-old female patient received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, lot number: EH9899), via an unspecified route of administration on 18Dec2020 at single dose for COVID-19 immunisation. The patient medical history and concomitant medications were not reported. The patient stated, "the day after the injection, my left arm and breast were tender with some mild body aches and low grade headache. Sunday Arm soreness went away but left breast was increasingly painful with swollen palpable lymph nodes, with body soreness and stiffness. Monday left breast is still remarkably tender with palpable lymph nodes" on 19Dec2020 (reported as Seriousness criteria-Caused/prolonged hospitalization: Yes, on an unspecified date in Dec2020). The outcome of the event was not recovered.; Sender''s Comments: The reported information is limited. Based on the close temporal relationship and the description of the events, there is a reasonable possibility that the events are related to BNT162 vaccine. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate. |
|
| VAERS ID: |
915464 (history) |
| Form: |
Version 2.0 |
| Age: |
29.0 |
| Sex: |
Female |
| Location: |
Unknown |
| Vaccinated: | 2020-12-28 |
| Onset: | 2020-12-28 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-31 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL1284 / 1 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Hypoaesthesia oral,
Paraesthesia oral,
Swollen tongue,
Tongue dry
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: asthma
Allergies: no known allergies
Diagnostic Lab Data:
CDC Split Type:
Write-up: 10 minutes after receiving vaccine, patient reported numbness across upper lip which progressed to her tongue. Felt tingling and dryness of tongue and swelling. No difficulty breathing or swallowing, no chest pain, no wheezing, no rash, no itching. Taken to ED and given methylprednisolone 125mg IV, diphenhydramine 50mg IV, famotidine 20mg PO. Patient improved and monitored x 4 hours with resolution of symptoms. Prescribed prednisone 50mg po x 4 days. |
|
| VAERS ID: |
915478 (history) |
| Form: |
Version 2.0 |
| Age: |
55.0 |
| Sex: |
Male |
| Location: |
Georgia |
| Vaccinated: | 2020-12-30 |
| Onset: | 2020-12-31 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-31 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
039K20A / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Dystonic tremor,
Erythema,
Headache,
Tachycardia,
Tachypnoea
SMQs:, Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (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: Crestor, Allopurinol
Current Illness: N/A
Preexisting Conditions: Recovered from COVID 19. Positive on 9/11/2020
Allergies: Iodine
Diagnostic Lab Data:
CDC Split Type:
Write-up: erythema, tachycardia, tachypnea, headache, uncontrolled dystonic shaking |
|
| VAERS ID: |
915480 (history) |
| Form: |
Version 2.0 |
| Age: |
75.0 |
| Sex: |
Female |
| Location: |
Minnesota |
| Vaccinated: | 2020-12-29 |
| Onset: | 2020-12-30 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-31 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
026L20A / 1 |
- / IM |
Administered by: Senior Living Purchased by: ?
Symptoms: Chest X-ray normal,
Chills,
Injection site erythema,
Injection site induration,
Laboratory test normal,
Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), 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, 1 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vitamin D3 4,000 units daily, famotidine 20 mg daily, ferrous sulfate 325 mg daily, gabapentin 400 mg BID, levothyroxine 100 mcg daily, melatonin 9 mg at hs, metoprolol tartrate 12.5 mg BID, nortriptyline 10 mg at HS, Norvasc 10 mg daily, S
Current Illness: Had a uti 12/8/2020 finished abx on 12/10/2020; prior to admitting had COVID with multiple complications spent along time in the hospital recovering.
Preexisting Conditions: Type 2 diabetes, morbid obesity, hypertension, sleep apnea, anemia, GERD, chronic pain
Allergies: Benzalkonium, lisinopril, Percocet, Adhesive Tape
Diagnostic Lab Data: Sent to ER admitted to hospital under observation. Per Hospital notes "There does not appear to be a cellulitis or abscess at this time. Labs and chest x-ray in the ED did not reveal any origin to where her fevers may be coming from".
CDC Split Type:
Write-up: Developed sudden onset of shaking chills and fevers as high as 103.0. She has developed a small circular 5 x 5 area of erythema and firmness at the injection site of her left upper arm. |
|
| VAERS ID: |
915562 (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: |
2020-12-31 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL0142 / 1 |
AR / IM |
Administered by: Senior Living Purchased by: ?
Symptoms: Death,
Dyspnoea,
Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)
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:
Preexisting Conditions:
Allergies: none listed
Diagnostic Lab Data:
CDC Split Type:
Write-up: pt received vaccine at covid clinic on 12/30 at approximately 3:30, pt vomited 4 minutes after receiving shot--dark brown vomit, staff reported pt had vomited night before. Per staff report pt became short of breath between 6 and 7 pm that night. Pt had DNR on file. pt passed away at approximately 10pm. Staff reported pt was 14 + days post covid |
|
| VAERS ID: |
915612 (history) |
| Form: |
Version 2.0 |
| Age: |
33.0 |
| Sex: |
Male |
| Location: |
Illinois |
| Vaccinated: | 2020-12-22 |
| Onset: | 2020-12-22 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-31 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EJ1685 / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Flushing,
Hypoaesthesia,
Neuralgia,
Paraesthesia,
Rash,
Small fibre neuropathy
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (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? Yes
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: My ID docs called a neurologist in our group, Dr. He saw me on December 29th in which he said this could potentially be guillain barre or it could just be a allergy reaction, both due to the covid vaccine. He did a full evaluation and found that I had neuropathic pain in my right hand and right foot. As of the 29th, the numbness and tingling was back to my right foot also and would come and go. He gave me a shot of decadron 1g (even though it would blunt my antibody titer response to the vaccine) and gave me extended release gabapentin to start on the evening of the 29th. He also had me start a Medrol dose pack starting on the 30th (today). 12-30-2020 Dr. did a STAT EMG which came back fairly normal. He can almost definitively say this is not guillain barre although he still concerned about some of the more rare de-myelinating brain disorders caused from vaccines. he said the most likely on the differential is a small fiber peripheral neuropathy stimulated from the lipid moiety that encompasses the messenger RNA of the mRNA vaccine. He told me to continue the prescribed meds and he is going to do a biopsy on Monday to try to diagnose the small fiber peripheral neuropathy.
CDC Split Type:
Write-up: Received my vaccine on December 22nd, 2020 at around 830 Am. That afternoon, about 3 PM, I started to have a reaction. It started with tingling/numbness in my right hand which progressed up my arm into my elbow. About 10 minutes later, it then progressed into my right foot, and my left foot. About 10 minutes after that, I started to get flushed and a neck rash (diagnosed from Dr.). I took Benadryl and Ibuprofen 800mg PO every 6 hours for the next 24 hours. The numbness in my right foot and left foot along with the flushness went away a couple hours later. Although, the numbness in my right hand never went away. It came and went for the next 4 days until December 27th and 28th when it started getting worse. On December 28th evening, it got so bad that I was debating going to the emergency room around 1 am. The numbness and tingling was in my right hand and started shooting up my arm. The nerve pain around my wrist was unbearable. I finally fell asleep and the next morning, it was not nearly as bad, but was still there. The numbness and tingling moved from my right hand mainly to right hand, right foot, right leg, left foot and left hand today (12-30-2020). |
|
| VAERS ID: |
915613 (history) |
| Form: |
Version 2.0 |
| Age: |
33.0 |
| Sex: |
Male |
| Location: |
Illinois |
| Vaccinated: | 2020-12-17 |
| Onset: | 2020-12-19 |
| Days after vaccination: | 2 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-31 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EJ685 / 1 |
LA / IM |
Administered by: Unknown Purchased by: ?
Symptoms: Angioedema,
Blood glucose increased,
Hyperglycaemia
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Oropharyngeal allergic conditions (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: angiodema. hospitalized overnight. During the hospitalization pt was started on an epi gtt and given MTP 125 mg. He had subsequent hyperglycemia, and increased his rate on his insulin pump to 2 U/hr (from 0.83 U/hr). Pt then decreased his rate to 1.4 U/hr while on the epi gtt, and then to 1.1 U/hr when off of the epi gtt. He also strengthened his carb ratio from 1:12 to 1:10 last night.Pt reports he had postprandial hyperglycemia overnight after his meal, but then BG corrected overnight. Pt reports fasting this morning is in the 110s. This morning''s breakfast on 1:10 CR with well controlled BG. |
|
| VAERS ID: |
915682 (history) |
| Form: |
Version 2.0 |
| Age: |
85.0 |
| Sex: |
Female |
| Location: |
Kentucky |
| Vaccinated: | 2020-12-30 |
| Onset: | 2020-12-30 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-31 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
LA / IM |
Administered by: Senior Living Purchased by: ?
Symptoms: Cardiac arrest,
Death,
Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad), Noninfectious myocarditis/pericarditis (broad)
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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Respiratory Disease, Essential Hypertension, Coronary Artery Disease, History of positive COVID 11/17/20
Allergies: No Known allergies
Diagnostic Lab Data:
CDC Split Type:
Write-up: Resident received vaccine per pharmacy at the facility at 5 pm. Approximately 6:45 resident found unresponsive and EMS contacted. Upon EMS arrival at facility, resident went into cardiac arrest, code initiated by EMS and transported to hospital. Resident expired at hospital at approximately 8 pm |
|
| VAERS ID: |
915690 (history) |
| Form: |
Version 2.0 |
| Age: |
28.0 |
| Sex: |
Female |
| Location: |
Texas |
| Vaccinated: | 2020-12-21 |
| Onset: | 2020-12-21 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-31 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EJ1685 / 1 |
LA / IM |
Administered by: Work Purchased by: ?
Symptoms: Consciousness fluctuating,
Discomfort,
Exposure during pregnancy,
Fatigue,
Headache,
Nausea,
Palpitations
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), 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: Maxalt 10mg Elavil 10mg
Current Illness: Anxiety
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:
Write-up: Due Date unknown/6-7 wks pregnant -nausea -Body felt heavy -headache -in & out consciousness -Fatigue, severe -Heart Racing |
|
| VAERS ID: |
915765 (history) |
| Form: |
Version 2.0 |
| Age: |
46.0 |
| Sex: |
Female |
| Location: |
Missouri |
| Vaccinated: | 2020-12-18 |
| Onset: | 2020-12-19 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-31 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL0140 / 1 |
RA / IM |
Administered by: Other Purchased by: ?
Symptoms: Anaphylactic reaction
SMQs:, Anaphylactic reaction (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypersensitivity (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Patient had an anaphylactic reaction to the vaccine the day after it was given and went to the nearest ER. |
|
