|
| VAERS ID: |
919593 (history) |
| Form: |
Version 2.0 |
| Age: |
64.0 |
| Sex: |
Male |
| Location: |
Iowa |
| Vaccinated: | 2020-12-30 |
| Onset: | 2021-01-02 |
| Days after vaccination: | 3 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-04 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
- / 1 |
RA / - |
Administered by: Unknown Purchased by: ?
Symptoms: Arthritis bacterial,
Culture wound positive
SMQs:, Arthritis (narrow)
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:
Other Medications:
Current Illness: none
Preexisting Conditions: hypertension, sleep apnea, osteoarthritis
Allergies: opioids
Diagnostic Lab Data: Positive wound cultures.
CDC Split Type:
Write-up: Patient developed a septic knee (history of arthroplasty) need for immediate surgery, hospitalization and months to years of antibiotics in his future now. |
|
| VAERS ID: |
919604 (history) |
| Form: |
Version 2.0 |
| Age: |
30.0 |
| Sex: |
Female |
| Location: |
Mississippi |
| Vaccinated: | 2020-12-30 |
| Onset: | 2020-12-30 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-04 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
037K20A / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Alanine aminotransferase normal,
Anion gap decreased,
Aspartate aminotransferase normal,
Basophil count normal,
Basophil percentage decreased,
Blood albumin normal,
Blood alkaline phosphatase normal,
Blood bilirubin normal,
Blood calcium normal,
Blood chloride normal,
Blood creatinine normal,
Blood glucose normal,
Blood magnesium normal,
Blood potassium decreased,
Blood sodium normal,
Blood thyroid stimulating hormone normal,
Blood urea nitrogen/creatinine ratio,
Blood urea normal,
Carbon dioxide decreased,
Chest X-ray normal,
Chest discomfort,
Cough,
Dizziness,
Eosinophil count decreased,
Eosinophil percentage decreased,
Glomerular filtration rate,
Haematocrit normal,
Haemoglobin normal,
Hypoaesthesia,
Immature granulocyte count increased,
Immature granulocyte percentage increased,
Injection site hypoaesthesia,
Injection site pain,
Lymphocyte count decreased,
Lymphocyte percentage decreased,
Mean cell haemoglobin concentration normal,
Mean cell haemoglobin normal,
Mean cell volume normal,
Mean platelet volume normal,
Monocyte count normal,
Monocyte percentage decreased,
Nausea,
Neutrophil count increased,
Neutrophil percentage increased,
Pain in extremity,
Platelet count normal,
Protein total normal,
Red blood cell count normal,
Red blood cell nucleated morphology,
Red cell distribution width increased,
Throat tightness,
Troponin normal,
White blood cell count normal
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Haematopoietic leukopenia (narrow), Peripheral neuropathy (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Myelodysplastic syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (narrow), Sexual dysfunction (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? Yes, 1 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amitriptyline 25 mg PO QHS Bupropion XL 150 mg PO Daily Cyanocobalamin 1000 mcg PO once weekly Ferrous sulfate DR 324 mg PO Daily Levothyroxine 100 mcg PO Daily Methocarbamol 500 mg PO TID prn muscle spasms Scopolamine 1.5 mg patch transder
Current Illness:
Preexisting Conditions: Anemia Asthma Depression Hypothyroidism secondary to thyroid cancer s/p thyroidectomy Hypertension Migraines Vertigo
Allergies: No known allergies
Diagnostic Lab Data: Chest X-ray (12/30/20 @ 1737): The cardiac and mediastinal silhouette are unremarkable. The lungs are free of infiltrates and masses. I see no acute chest disease on today''s film. CBC w/diff (12/30/2020 @ 1658) WBC: 9.0 RBC: 4.38 Hemoglobin: 13.3 Hematocrit: 39.8 MCV: 90.9 MCH: 30.4 MCHC: 33.4 RDW SD: 40.4 Platelet: 264 MPV: 9 NRBC Percent: 0.0 NRBC Absolute: 0.000 Absolute Neutrophil: 8.4 (H) Lymphocyte Absolute: 0.4 (L) Monocytes Absolute, Automated: 0.11 Absolute Eosinophil: 0.00 (L) Basophil Absolute: 0.03 Absolute Immature Granulocytes: 0.03 (H) Neutrophil percent: 93.6 (H) Lymphocyte percent: 4.6 (L) Monocyte percent: 1.2 Eosinophil percent: 0.0 Basophil percent: 0.3 Immature Granulocytes percent: 0.30 (H) CMP (12/30/2020 @ 1658) Sodium: 136 Potassium: 3.3 (L) Chloride: 106 CO2: 21 Anion gap: 9 Glucose: 137 (H) BUN: 15 Creatinine: 1.01 BUN/Creatinine Ratio: 14.9 Calcium: 9.2 Protein total: 7.9 Albumin: 4.6 AST: 12 ALT: 17 ALP: 50 eGFR non-African American: $g60.0 eGFR African American: $g60.0 Bilirubin total: 0.4 Magnesium: 2.0 TSH: 2.52 Cardiovascular (12/30/2020 @ 1658) Troponin: <0.015
CDC Split Type:
Write-up: Presented to the ED after developing chest tightness, cough, lightheadedness, and throat closing sensation. She received the Moderna COVID-19 vaccine on the morning of presentation. Within 15 minutes of receiving the vaccine she developed pain and numbness, starting at the injection site traveling down the ulnar aspect of her arm, and nausea. Over the next several hours she continued to develop worsening nausea, chest tightness, cough, lightheadedness, and the sensation that her throat closing. She took PO Benadryl 25mg; however, her symptoms were not alleviated. She was subsequently evaluated in the ED. ? Received PO Benadryl 25mg, IV Benadryl 25mg, Epinephrine 0.3mg x 2, IV Famotidine 20mg, IV Solumedrol 125mg & 60mg, DuoNebs x 3, Racepinephrine x 1. |
|
| VAERS ID: |
919620 (history) |
| Form: |
Version 2.0 |
| Age: |
81.0 |
| Sex: |
Male |
| Location: |
Washington |
| Vaccinated: | 2020-12-01 |
| Onset: | 2021-01-01 |
| Days after vaccination: | 31 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-04 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL0140 / 1 |
LA / IM |
| UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER |
EL0140 / 1 |
UN / - |
Administered by: Senior Living Purchased by: ?
Symptoms: Body temperature increased,
Cardiac failure,
Pyrexia
SMQs:, Cardiac failure (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Noninfectious myocarditis/pericarditis (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, 3 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Mucus Relief Tablet 400 MG (GuaiFENesin) Give 1 tablet by mouth every 8 hours as needed for congestion Prescriber Entered Active01/02/202101/04/2021 Omeprazole Capsule Delayed Release 40 MG Give 1 capsule by mouth in the morning for GERD Ph
Current Illness: N/A
Preexisting Conditions: Dementia, Urinary Incontinence, depression, Edema
Allergies: No
Diagnostic Lab Data:
CDC Split Type:
Write-up: Decompensation and temp 103.6. |
|
| VAERS ID: |
919624 (history) |
| Form: |
Version 2.0 |
| Age: |
29.0 |
| Sex: |
Female |
| Location: |
Pennsylvania |
| Vaccinated: | 2020-12-29 |
| Onset: | 2020-12-29 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-04 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
011J20A / 1 |
LA / IM |
Administered by: Work Purchased by: ?
Symptoms: Asthenia,
Blood pressure decreased,
Chills,
Decreased appetite,
Dizziness,
Fatigue,
Headache,
Hot flush,
Lymphadenopathy,
Mobility decreased,
Nausea,
Pain in extremity,
Paraesthesia,
Speech disorder,
Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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, ? days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: no
Allergies: Penicillin
Diagnostic Lab Data: no
CDC Split Type:
Write-up: Around 10 or 11 pm, arm pain, chills, fatigue, headache, nausea, swollen lymph nodes, lightheadedness, fainted in tub. Next day, fatigue all day, couldn''t talk, or eat. Went back to bed again. The following day hot flashes, weakness. went to ER. Felt like blood pressure was dropping, tingling in legs, difficulty lifting her head. |
|
| VAERS ID: |
919629 (history) |
| Form: |
Version 2.0 |
| Age: |
51.0 |
| Sex: |
Female |
| Location: |
Ohio |
| Vaccinated: | 2021-01-04 |
| Onset: | 2021-01-04 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-04 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EJ1605 / 1 |
LA / IM |
Administered by: Senior Living Purchased by: ?
Symptoms: Erythema,
Feeling abnormal,
Hyperhidrosis,
Malaise,
Oxygen saturation decreased,
Pain in extremity,
Pruritus
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Hypersensitivity (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: 20 minutes after receiving the vaccination the resident started to not feel well. She said she felt very far away and just kept repeating I don''t feel well. She was diaphoretic and her chest was very red and she kept scratching and rubbing it at it. I asked if she wanted IM Benadryl or epipen and she at first denied. She also said she felt like she needed to focus on her breathing. At this time we decided it was best to administer Epipen x 1 dose. Immediately after she felt better. She was observed for another 30 minutes and then went home. at 7:17pm I called and spoke with her. She said her arm was sore and that her oxygen levels were about 88-89% which is low for her but she said she felt fine and is currently working right now. |
|
| VAERS ID: |
919633 (history) |
| Form: |
Version 2.0 |
| Age: |
49.0 |
| Sex: |
Female |
| Location: |
Mississippi |
| Vaccinated: | 2020-01-04 |
| Onset: | 2020-12-30 |
| Days after vaccination: | 361 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-04 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
037K20A / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Alanine aminotransferase normal,
Angiogram cerebral normal,
Anion gap decreased,
Arteriogram carotid normal,
Aspartate aminotransferase normal,
Basophil count normal,
Basophil percentage,
Blood albumin normal,
Blood alkaline phosphatase normal,
Blood bilirubin normal,
Blood calcium normal,
Blood chloride normal,
Blood creatinine normal,
Blood glucose normal,
Blood potassium normal,
Blood sodium normal,
Blood urea nitrogen/creatinine ratio,
Blood urea normal,
Carbon dioxide normal,
Chest X-ray normal,
Computerised tomogram head normal,
Electrocardiogram,
Eosinophil count normal,
Eosinophil percentage,
Facial paralysis,
Facial paresis,
Feeling hot,
Glomerular filtration rate,
Haematocrit normal,
Haemoglobin normal,
Hypoaesthesia,
Immature granulocyte count increased,
Immature granulocyte percentage increased,
Immediate post-injection reaction,
Injection site hypoaesthesia,
Injection site warmth,
Lymphocyte count normal,
Lymphocyte percentage decreased,
Mean cell haemoglobin concentration normal,
Mean cell haemoglobin decreased,
Mean cell volume normal,
Mean platelet volume increased,
Monocyte count normal,
Monocyte percentage,
Muscular weakness,
Nausea,
Neutrophil count normal,
Neutrophil percentage increased,
Palpitations,
Platelet count normal,
Protein total normal,
Red blood cell count normal,
Red blood cell nucleated morphology,
Red cell distribution width,
White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Haematopoietic leukopenia (broad), Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hearing impairment (broad), Hypersensitivity (narrow), Myelodysplastic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (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? Yes
Hospitalized? Yes, 1 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol 90 mcg/actuation 2 puffs inhaled q4h prn sob/wheezing Aspirin EC 81 mg PO Daily Bupropion SR 150 PO Daily Calcium carbonate + Vitamin D 600mg PO Daily Cinnamon Bark 2 capsules PO Daily prn Clonazepam 0.5 mg PO Daily prn anxiety Cl
Current Illness: N/A
Preexisting Conditions: Asthma Fibrocystic breast disease Hyperlipidemia Irritable bowel syndrome Insomnia Migraines Polycystic ovarian syndrome
Allergies: Latex gloves - Anaphylaxis Iodine - Swelling Shellfish - Unknown Oseltamivir - Unknown Tramadol - Itching, N/V
Diagnostic Lab Data: CT Head w/o contrast (12/31/20 @ 1813) READING: I see no evidence of hemorrhage, mass effect, abnormal attenuation, extra-axial lesions, ventriculomegaly or other suspicious intracranial pathology. Included paranasal sinuses, mastoids and middle ears are clear. Calvarium intact. IMPRESSION: no acute intracranial pathology Chest X-Ray (12/31/20 @ 1821) READING: No suspicious cardiomediastinal pathology. No infiltrates or other suspicious pulmonary or pleural pathology. I see no acute abnormality. CT Angiogram w/o contrast (12/31/20 @ 1816) READING: Both common carotid arteries and the vertebral arteries are patent and normal. Do not see any plaque or stenosis. Both carotid bifurcations are normal. The internal carotid arteries remain patent throughout the course without stenosis or occlusion in the basal artery is normal. Anterior posterior cerebral arteries widely patent without stenosis or occlusion. No arterial venous malformation or aneurysm or other vascular abnormalities. IMPRESSION: No arterial stenotic or occlusive disease of the head or neck EKC 12-Lead (12/31/20 @ 1728) Systolic Blood Pressure: 172 Diastolic Blood Pressure: 96 Vent Rate: 93 Atrial Rate: 93 PR Interval: 150 QRS Interval: 78 QT Interval: 356 QTC Interval: 442 P Axis: 66 R Axis: 25 T Axis: 22 CBC w/diff (12/31/20 @ 1845) WBC: 6.4 RBC: 5.28 Hemoglobin: 14.2 Hematocrit: 43.7 MCV: 82.8 MCH: 26.9 (L) MCHC: 32.5 RDW SD: 37.8 Platelet: 197 MPV: 11 (H) NRBC Percent: 0.0 NRBC Absolute: 0.000 Absolute Neutrophil: 4.9 Lymphocyte Absolute: 1.1 Monocytes Absolute, Automated: 0.38 Absolute Eosinophil: 0.07 Basophil Absolute: 0.05 Absolute Immature Granulocytes: 0.01 (H) Neutrophil percent: 75.2 (H) Lymphocyte percent: 16.8 (L) Monocyte percent: 5.9 Eosinophil percent: 1.1 Basophil percent: 0.8 Immature Granulocytes percent: 0.20 (H) CMP (12/31/20 @ 1845) Sodium: 138 Potassium: 3.9 Chloride: 105 CO2: 28 Anion gap: 5 (L) Glucose: 82 BUN: 19 (H) Creatinine: 0.88 BUN/Creatinine Ratio: 21.6 Calcium: 9.8 Protein total: 7.8 Albumin: 3.9 AST: 24 ALT: 23 ALP: 71 eGFR non-African American: $g60.0 eGFR African American: $g60.0 Bilirubin total: 0.8
CDC Split Type:
Write-up: Presented to the ED with cc of left sided facial and LUE numbness and weakness x 1 days. Patient received her COVID-19 vaccination on 12/30/2020 around 1PM. Immediately after the injection in her left shoulder, she began to feel warmth and numbness in her left shoulder, arm, neck, face, and chest. She reports later experiencing nausea, palpitations, and left arm weakness. Her symptoms persisted, and her family noted a left sided facial droop which prompted her ED visit. In the ED, patient was noted to have some left sided facial droop and left arm and leg weakness. CT head and CTA showed no acute abnormalities. Tele-neurology was consulted who recommended admission to rule out acute stroke. Ultimately, work up was negative and symptoms resolved. Symptoms appear to be related to the vaccine. |
|
| VAERS ID: |
919665 (history) |
| Form: |
Version 2.0 |
| Age: |
28.0 |
| Sex: |
Female |
| Location: |
New Jersey |
| Vaccinated: | 2020-12-29 |
| Onset: | 2020-12-29 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-04 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
011L20A / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Arthralgia,
Blood test,
Chest X-ray,
Nausea,
Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Synthroid Claritin Dexilent Terbinafine Vitamin D & B12
Current Illness:
Preexisting Conditions: Hypothyroid GERD
Allergies: Bactrim
Diagnostic Lab Data: Blood work 12/30/20 Chest X-ray 12/30/20
CDC Split Type:
Write-up: Severe joint aches, fever-type symptoms, nausea |
|
| VAERS ID: |
919743 (history) |
| Form: |
Version 2.0 |
| Age: |
50.0 |
| Sex: |
Female |
| Location: |
California |
| Vaccinated: | 2021-01-03 |
| Onset: | 2021-01-03 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-04 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
025J20-2A / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Chest discomfort,
Cough,
Dyspnoea,
Flushing
SMQs:, Anaphylactic reaction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), 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? Yes
Hospitalized? No
Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Cough began approx 5 min post vaccine, then pt experienced flushing of neck, chest tightness and SOB. Placed on O2 mask at 8L/min, given 1 dose of Epi and transferred to ED |
|
| VAERS ID: |
919783 (history) |
| Form: |
Version 2.0 |
| Age: |
26.0 |
| Sex: |
Female |
| Location: |
Texas |
| Vaccinated: | 2020-12-23 |
| Onset: | 2020-12-24 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-04 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
ELO140 / 1 |
RA / IM |
Administered by: Other Purchased by: ?
Symptoms: Hypoaesthesia,
Pain in extremity,
Pallor,
Poor peripheral circulation,
Skin discolouration
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), Sexual dysfunction (broad)
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: TriSplintec Oral Contraceptives
Current Illness: N/A
Preexisting Conditions: Tortuous Colon
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:
Write-up: On 12/24 at around 10 PM, circulation to my 4th left digit significantly decreased after being outside of my car for around 15 minutes during a temperature of about 50 degrees. I realized when sharp pain was felt at the digit. After about 5 minutes the digit felt numb. I got in my car, turned on the heater, and massaged my finger. Sharp pain was felt again as circulation returned to the digit. The event last approximately 10 minutes from the moment I realized the finger was pale until color returned. This occurred again on 12/27 at around 2 PM as I walked from my car into a store at a temperature of about 40 degrees. This time, discoloration occurred bilaterally on my left 3rd, 4th, and 5th digits and my right 2nd, 3rd, 4th, and 5th digits. The event lasted more than 15 minutes with constant massaging. This has occurred two more times since then, both times occurring bilaterally with minimal exposure to cold. |
|
| VAERS ID: |
919827 (history) |
| Form: |
Version 2.0 |
| Age: |
45.0 |
| Sex: |
Male |
| Location: |
California |
| Vaccinated: | 2020-12-22 |
| Onset: | 2020-12-23 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-05 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
11J20A / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Abdominal pain lower,
Abdominal pain upper,
Appendicectomy,
Appendicitis,
Computerised tomogram abdomen abnormal,
Discomfort,
Nausea,
Pain
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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, 1 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: penicillin
Diagnostic Lab Data: evaluated by urgent care physicians and determined to likely be presenting with an appendicitis. Diagnosis of acute appendicitis confirmed and surgery performed to remove appendix.
CDC Split Type:
Write-up: Began experiencing nausea and general stomach pains the morning after receiving the vaccine. After one day of pain and discomfort I woke the following morning (~44hrs after receiving the vaccine) to extreme acute abdominal pain in the lower right abdomen. Went to Urgent Care facility and was diagnosed by CT scan as having acute appendicitis. An emergency appendectomy was scheduled and performed for later that evening. I stayed at the Hospital overnight on 12/24/2020 post operatively on IV antibiotics to recover from the appendectomy. Was discharged from the hospital on 12/25/2020 and have been recovering for about 10 days now with limitted activity. |
|
