|
| VAERS ID: |
903766 (history) |
| Form: |
Version 2.0 |
| Age: |
36.0 |
| Sex: |
Female |
| Location: |
Arizona |
| Vaccinated: | 2020-12-17 |
| Onset: | 2020-12-17 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-18 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Angioedema,
Full blood count,
Human chorionic gonadotropin,
Metabolic function test
SMQs:, Anaphylactic reaction (broad), Angioedema (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? Yes
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Levothyroxine 100 mcg, albuterol HFA, Wellbutrin XL
Current Illness: None
Preexisting Conditions: CSF leak, migraines, asthma
Allergies: Amoxicillin (hives), divalproex (swelling)
Diagnostic Lab Data: CBC, BMP, HCG
CDC Split Type:
Write-up: Angioedema |
|
| VAERS ID: |
903800 (history) |
| Form: |
Version 2.0 |
| Age: |
40.0 |
| Sex: |
Female |
| Location: |
Puerto Rico |
| Vaccinated: | 2020-12-17 |
| Onset: | 2020-12-17 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-18 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / UNK |
LA / SYR |
Administered by: Public Purchased by: ?
Symptoms: Chest X-ray,
Chest pain,
Dyspnoea,
Electrocardiogram,
Full blood count,
Malaise,
Metabolic function test,
Nausea,
Throat tightness,
Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (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: asthma
Preexisting Conditions: asthma
Allergies: seafood, barbiturates, caffeine, oxycodone, demerol, morphine, acetaminophen, nalbuphine
Diagnostic Lab Data: cbc, bmp, ekg, Chest xray
CDC Split Type:
Write-up: sob, nausea, malaise, vomit, chest pain, throat tightness |
|
| VAERS ID: |
903806 (history) |
| Form: |
Version 2.0 |
| Age: |
89.0 |
| Sex: |
Female |
| Location: |
Florida |
| Vaccinated: | 2020-12-17 |
| Onset: | 2020-12-18 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-18 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
LA / IM |
Administered by: Senior Living Purchased by: ?
Symptoms: Dyspnoea,
SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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: Lorazepam, Depakote, Trazadone, Coreg, Bumetanide, Senna, Bumetanide
Current Illness: Mild cough
Preexisting Conditions: A fib, Gastro reflux, type 2 diabetes, hypertension, edema, anxiety, heart failure, pacemaker, obesity, OA, anemia
Allergies: Codeine, morphine, propafenone
Diagnostic Lab Data: Tests performed at hospital
CDC Split Type:
Write-up: Resident became short of breath 7 hours after vaccine, went to hospital, was COVID+ |
|
| VAERS ID: |
903820 (history) |
| Form: |
Version 2.0 |
| Age: |
85.0 |
| Sex: |
Male |
| Location: |
Florida |
| Vaccinated: | 2020-12-17 |
| Onset: | 2020-12-18 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-18 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
LA / IM |
Administered by: Senior Living Purchased by: ?
Symptoms: Dyspnoea,
Laboratory test,
Pyrexia,
SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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, 1 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: eye drops, hydroxyzine, Ivermectin, Xarelto, donepezil, finasteride, melatonin, Tamsulosin, atorvastatin, fluxetine
Current Illness: None
Preexisting Conditions: Dementia, anxiety, glaucoma, hyperlipidemia, COPD
Allergies: Morphine
Diagnostic Lab Data: tests performed at hospital
CDC Split Type:
Write-up: Day following vaccine, fever, sob - went to hospital, COVID+ |
|
| VAERS ID: |
903931 (history) |
| Form: |
Version 2.0 |
| Age: |
29.0 |
| Sex: |
Male |
| Location: |
Washington |
| Vaccinated: | 2020-12-17 |
| Onset: | 2020-12-18 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-18 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
AR / SYR |
Administered by: Military Purchased by: ?
Symptoms: Abdominal pain,
Blood creatinine increased,
C-reactive protein increased,
Computerised tomogram abdomen,
Computerised tomogram abnormal,
Dehydration,
Gastrointestinal inflammation,
Gastrointestinal wall thickening,
Haematocrit increased,
Scan with contrast abnormal,
Small intestinal obstruction
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Retroperitoneal fibrosis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific inflammation (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Chronic kidney disease (broad), Noninfectious diarrhoea (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (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, ? days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Denies any home medications
Current Illness: None
Preexisting Conditions: None
Allergies: Denies any allergies
Diagnostic Lab Data: 12/18/20 - CT Abdomen and Pelvis w/ Contrast
CDC Split Type:
Write-up: Presented with periumbilical pain to emergency department (patient works at Medical Center). Admitted to hospital for small bowel obstruction. Labs were consistent with dehydration (Hct 55, Cr 1.25), as well as CRP 1.10. A CT Abd/Pelvis identified proximal dilation and fecalization of small bowel, with a transition point in the left lower quadrant. Distal to the transition point, the small bowel appears thick, with hyperenhancement and inflammation progressing into the cecum. General Surgery was consulted and patient admitted to hospital for management of this small bowel obstruction. |
|
| VAERS ID: |
903938 (history) |
| Form: |
Version 2.0 |
| Age: |
29.0 |
| Sex: |
Female |
| Location: |
Texas |
| Vaccinated: | 2020-12-18 |
| Onset: | 2020-12-18 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-18 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EJ1685 / 1 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Injection site induration,
Injection site pain,
Injection site rash,
Injection site warmth,
Rash
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (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? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Microgestin
Current Illness: none
Preexisting Conditions: none
Allergies: NKA
Diagnostic Lab Data: 6:11PM: 185/71 Temp 98.2 sat 98% HR85
CDC Split Type:
Write-up: rash appeared at site of injection, very painful, hot to touch, hard, with rash spreading to torso |
|
| VAERS ID: |
904029 (history) |
| Form: |
Version 2.0 |
| Age: |
35.0 |
| Sex: |
Female |
| Location: |
Mississippi |
| Vaccinated: | 2020-12-18 |
| Onset: | 2020-12-18 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-19 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EK5730 / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Chest discomfort,
Cyanosis,
Dizziness,
Dyspnoea,
Full blood count,
Livedo reticularis,
Metabolic function test,
Mobility decreased,
Muscle spasms,
Muscular weakness,
Nail bed disorder,
Paraesthesia,
Pregnancy test,
Pruritus,
Rash,
SARS-CoV-2 antibody test,
SARS-CoV-2 test,
Skin discolouration,
Syncope,
Urticaria,
Weight bearing difficulty
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (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? No
Previous Vaccinations:
Other Medications: Topamax 50mg daily, Celexa 10mg daily, Imitrex 100mg PRN
Current Illness: None
Preexisting Conditions: Migraines
Allergies: PCN- unknown reaction, was just always just told was, but no history of a anaphylaxis and able to tolerate cephalosporins.
Diagnostic Lab Data: Cbc, cmp, rapid COVId PCR, Covid antibody, pregnancy test
CDC Split Type:
Write-up: 15 minutes after getting the vaccine began itching that quickly developed into rash/hives to face, neck, chest, abdomen. At 20 minutes post vaccine developed severe leg weakness with lightheadedness, chest tightness, and SOB. 22 minutes out collapsed to the floor unable to bear weight due to leg weakness and had severe cramping and tingling in legs, still unable to move them. Was rushed to the ER from employee health and arrived approximately 30 minutes post vaccine administration at that time there was significant mottling to arms and hands with polar nail beds. Vital signs were stable, no strider. Given Solumedrol, Benadryl, and Pepcid STAT. Rash/hives and SOB improved, but legs weakness/tingling, cramping did not and noted purple feet with cyanotic nail beds and mottling to hands/ arms that would come and go. Rash/hives reappeared much worse 2 horse post meds to face, neck, and upper chest. Was given another series of Solumedrol and Benadryl and admitted to the hospital. I am now 19 hours post vaccine with improved but persistent leg weakness, now able to bear my own weight independently and walk a few steps, but still having legs cramps and intermittent tingling to feet. Color has improved with resolved mottling/cyanosis. I continue to have hives reappear with scheduled Benadryl, Solumedrol, and Pepcid. |
|
| VAERS ID: |
904072 (history) |
| Form: |
Version 2.0 |
| Age: |
34.0 |
| Sex: |
Female |
| Location: |
New York |
| Vaccinated: | 2020-12-18 |
| Onset: | 2020-12-18 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-19 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EK5730 / 1 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Chest discomfort,
Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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: allegra Klonopin Lamictal Latuda Implanon PRILOSEC Synthroid albuterol inhaler
Current Illness:
Preexisting Conditions: Asthma gerd hypothyroid gastric sleeve GI bleed
Allergies: Latex, eggs, pork, shellfish, beef, cinamon
Diagnostic Lab Data:
CDC Split Type:
Write-up: Chest Tightness and shortness of breath |
|
| VAERS ID: |
904093 (history) |
| Form: |
Version 2.0 |
| Age: |
32.0 |
| Sex: |
Female |
| Location: |
Florida |
| Vaccinated: | 2020-12-18 |
| Onset: | 2020-12-18 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-19 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / UNK |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Formication,
Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre 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? No
Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: shellfish, crustaceans
Diagnostic Lab Data:
CDC Split Type:
Write-up: Tingly sensations all over body on and off, like crawling feeling for 12 plus hours. No shortness of breathe noted or blisters/break outs. |
|
| VAERS ID: |
904107 (history) |
| Form: |
Version 2.0 |
| Age: |
82.0 |
| Sex: |
Male |
| Location: |
Florida |
| Vaccinated: | 2020-12-19 |
| Onset: | 2020-12-19 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-19 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EH9899 / 1 |
RA / IM |
Administered by: Senior Living Purchased by: ?
Symptoms: Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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, ? days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Probiotic Capsule, Macrobid Capsule 100 MG, Simethicone Tablet 80 MG, Meloxicam Tablet 7.5 MG, Asmanex HFA Aerosol 100 MCG/ACT (Mometasone Furoate), Incruse Ellipta Aerosol Powder Breath Activated 62.5 MCG/INH (Umeclidinium Bromide), Mirta
Current Illness: SEPSIS, UNSPECIFIED ORGANISM, THROMBOCYTOPENIA, ADULT FAILURE TO THRIVE, CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Preexisting Conditions: COPD, Adult failure to thrive
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:
Write-up: Resident short of breath approximately 10 minutes post vaccination. Staff noted that his baseline upon activity and transferring is generally shortness of breath. Resident wears 2L NC, O2 saturation was 92%, increased to NC to 4 Liters O2 saturation up to 96%. 170/80, heart rate 94, regular rhythm. Sent to hospital. |
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