|
| VAERS ID: |
906733 (history) |
| Form: |
Version 2.0 |
| Age: |
50.0 |
| Sex: |
Female |
| Location: |
Maryland |
| Vaccinated: | 2020-12-21 |
| Onset: | 2020-12-21 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-22 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
RA / IM |
Administered by: Work Purchased by: ?
Symptoms: Anaphylactic reaction
SMQs:, Anaphylactic reaction (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypersensitivity (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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: yes
Diagnostic Lab Data:
CDC Split Type:
Write-up: anaphylaxis |
|
| VAERS ID: |
906782 (history) |
| Form: |
Version 2.0 |
| Age: |
44.0 |
| Sex: |
Male |
| Location: |
California |
| Vaccinated: | 2020-12-18 |
| Onset: | 2020-12-18 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-22 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
CK5730 / 1 |
LA / IM |
Administered by: Other Purchased by: ?
Symptoms: Cold sweat,
Dizziness,
Dysgeusia,
Feeling abnormal,
Hot flush,
Hypoaesthesia,
Pallor,
Paraesthesia,
Peripheral coldness
SMQs:, Peripheral neuropathy (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (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: multivitamines
Current Illness: none
Preexisting Conditions: none
Allergies: noe
Diagnostic Lab Data: Rapid Response was called BP and SpO2 was checked, I don''t know the results, on 12/18/2020.
CDC Split Type:
Write-up: Received COVID-19 vaccine on 12/18/2020 around 1225pm, ten minutes later while being monitored I started to feel hot flash, got dizzy like about to pass out, I asked to let me lay down, I felt the medication bitter taste in the back of my throat, I was clammy pale, I lay on a stretcher and put my feet up elevated, rapid response was called and BP was checked and Spo2, my hands were getting cold and tingling I was talking to RN, another RN, after laying down for ten minutes I sit up I was getting my BP back to normal, I sat down in the chair again for another 10 minutes, I was offered to go to the ER but I decline, I said I was getting better, after 15 minutes I left monitored by my supervisor I felt the medication in my stomach, after the tingling my fingers were numbed for the next days until present. |
|
| VAERS ID: |
906910 (history) |
| Form: |
Version 2.0 |
| Age: |
56.0 |
| Sex: |
Male |
| Location: |
Florida |
| Vaccinated: | 2020-12-18 |
| Onset: | 2020-12-21 |
| Days after vaccination: | 3 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-22 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EH9899 / 1 |
AR / IM |
Administered by: Private Purchased by: ?
Symptoms: Blood bilirubin increased,
Blood osmolarity increased,
Blood urea increased,
Contusion,
Haemorrhage,
Immune thrombocytopenia,
Monocyte percentage increased,
Platelet count decreased,
Platelet transfusion,
Thrombocytopenia
SMQs:, Acute renal failure (broad), Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Systemic lupus erythematosus (narrow), Retroperitoneal fibrosis (broad), Biliary system related investigations, signs and symptoms (narrow), Accidents and injuries (narrow), Chronic kidney disease (broad), Hypersensitivity (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (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: No home medications at the time of vaccination or hospital admission
Current Illness: No pertinent past medical history prior to vaccination
Preexisting Conditions: No pertinent past medical history prior to vaccination
Allergies: No known allergies of any type
Diagnostic Lab Data: BP: 159/106 (12/22/20), Platelets 0 (12/22/20), monocytes 12.1% (12/22/20), BUN 22.3 (12/22/20), BILI 1.50 (12/22/20), calculated osmolality 297 (12/22/20). All other labs are w
CDC Split Type:
Write-up: HPI: 56 y.o. male with no pmhx c/o generalized bruising for 2 days, noticed small blood tinged spots generalized. Gradual onset, severe on severity, no alleviating or aggravating factors. Patient denies fevers, chills, N/V/D, abdominal pain. In ER: Platelet <1. Platelet transfusion in ER. Admitted for Thrombocytopenia/ITP |
|
| VAERS ID: |
906988 (history) |
| Form: |
Version 2.0 |
| Age: |
52.0 |
| Sex: |
Female |
| Location: |
Alabama |
| Vaccinated: | 2020-12-22 |
| Onset: | 2020-12-22 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-22 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EK5730 / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Anaphylactic reaction,
Bilevel positive airway pressure,
Lip swelling,
Nausea,
Status asthmaticus,
Wheezing
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Asthma/bronchospasm (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: NONE KNOWN
Current Illness: NONE KNOWN
Preexisting Conditions: ASTHMA
Allergies: SULFA - ANAPHYLAXIS / EXERBATION OF ASTHMA
Diagnostic Lab Data:
CDC Split Type:
Write-up: PT WAS OBSRVED IN HOLDING AREA LEANING FORWARD IN HER CHAIR ABOUT 7 MINUTES AFTER RECIEVING THE VACINE. RN ASSESSED AND NOTED: AUDIBLE WHEEZE, RESP 40/MIN, LIP SWELLING AND PT COMPLAINED OF NAUSEA. PT WAS ESCORTED TO ER IN WHEELCHAIR ACCOMPANIED BY 2 RN''S (2 MINUTE WALK) ONE HOUR LATER - AS REPORTED BY DR (ER) WORKING DIAGNOSIS - ANAPHYLAXIS / STATUS ASTHMATICUS MEDS RECIEVED: SOLUMEDROL 125, DIPHENHYDRAMINE 50MG, FAMOTIDINE 20MG --ALL IV EPINEPHERINE 0.3MG IM X1 FOLLOWED BY 0.3MG IV X 1 FOLLOWED BY 0.1MG IV X1 PT IS RECIEVING O2 - AND PROGRESSING TO BIPAP |
|
| VAERS ID: |
907022 (history) |
| Form: |
Version 2.0 |
| Age: |
44.0 |
| Sex: |
Female |
| Location: |
Ohio |
| Vaccinated: | 2020-12-22 |
| Onset: | 2020-12-22 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-22 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
011J20A / 1 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Anaphylactic reaction,
Angioedema,
Endotracheal intubation
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal allergic conditions (narrow), Hypersensitivity (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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? Yes, 1 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Calcium 600 mg with D daily; Women''s Multiple vitamin daily; Vitamin D3 5,000 units daily; Zyrtec 10 mg at bedtime PRN; Celebrex 200 mg daily; Gabapentin 300 mg (3 caps daily); Melatonin 9 mg daily PRN; Zanaflex 4 mg Daily
Current Illness: Not known
Preexisting Conditions: Anxiety; Depression; Chronic Back Pain
Allergies: Morphine; Tramadol; NSAIDs; Codeine; Oxycodone; Percocet
Diagnostic Lab Data: None at this time
CDC Split Type:
Write-up: Anaphylaxis/Angioedema Patient was given EpiPen 0.3 mg IM; Methylprednisolone 125 mg once; Diphenhydramine 25 mg IV push once; Famotidine 20 mg IV push once; Dexamethasone 10 mg IV push once Patient was intubated and put on propofol and midazolam drips for sedation |
|
| VAERS ID: |
907042 (history) |
| Form: |
Version 2.0 |
| Age: |
42.0 |
| Sex: |
Female |
| Location: |
Idaho |
| Vaccinated: | 2020-12-21 |
| Onset: | 2020-12-21 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-22 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EK5730 / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Abdominal pain upper,
Blood pressure increased,
Dizziness,
Dry eye,
Dysphonia,
Eye swelling,
Nausea,
Ocular discomfort,
Paraesthesia,
Paraesthesia oral,
Pulse abnormal,
Rash,
Rash erythematous,
Rash pruritic,
Swollen tongue,
Throat irritation,
Tongue pruritus,
Wheezing
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Conjunctival disorders (narrow), Lacrimal disorders (narrow), 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: Arm became swollen after receiving flu shot with preservative in 2010
Other Medications: Vitamin D, Claritin, magnesium, Zoloft
Current Illness: None
Preexisting Conditions: Asthma, PCOS, diverticuli
Allergies: Raglan, morphine, erythromycin, Zithromax, sulfa, macrobid, latex sensitivity, egg sensitivity, gluten sensitivity, gold
Diagnostic Lab Data: None
CDC Split Type:
Write-up: Received vaccine around 10:40 am, by 10:50 started to feel dizzy, eyes felt full, dry, tingly, swollen, voice became raspy and throat itched. Received 25 mg Benadryl PO at around 10:55. Face, arms, chest and abdomen developed a fine red itchy rash, tongue swollen and itchy, lips tingling, wheezing, blood pressure elevated, pulse thready given 25 mg PO Benadryl, taken to the Emergency Room, symptoms persisted, stomach hurt became nauseated, received IV solumedrol, Pepcid, IV fluids, nebulized albuterol. Sent home once stable after 3 hours, with instruction to take Benadryl every 4-6 hours fir the next 2 days, albuterol as needed, and prednisone for the next 5 days. |
|
| VAERS ID: |
907074 (history) |
| Form: |
Version 2.0 |
| Age: |
82.0 |
| Sex: |
Female |
| Location: |
Ohio |
| Vaccinated: | 2020-12-22 |
| Onset: | 2020-12-22 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-22 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EK5730 / 1 |
RA / IM |
Administered by: Senior Living Purchased by: ?
Symptoms: Atrial fibrillation,
Condition aggravated
SMQs:, Supraventricular tachyarrhythmias (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: atrial fibrillation hx
Preexisting Conditions: atrial fibrillation hx
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:
Write-up: EMS called after patient displayed a heart rate of 160, a little over an hour after vaccine administration. Patient was taken to the hospital and diagnosed with an episode of RVR Afib; she was admitted to the hospital. |
|
| VAERS ID: |
907075 (history) |
| Form: |
Version 2.0 |
| Age: |
43.0 |
| Sex: |
Female |
| Location: |
Ohio |
| Vaccinated: | 2020-12-22 |
| Onset: | 2020-12-22 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-22 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
039K20A / 1 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Bronchospasm,
Cough,
Tongue pruritus
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
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: Influenza - other information unknown
Other Medications: Prescription: atenolol, omeprazole, simvastatin, primidone, levothyroxine, escitalopram, albuterol inhaler
Current Illness: no
Preexisting Conditions: Hypothyroidism, asthma, high cholesterol, palpitations, essential tremor, anxiety, depression, hiatal hernia
Allergies: Medication allergies: morphine - anaphylaxis, flexeril - mood and behavior disturbances, zolpidem- shortness of breath, lamotrigine - shortness of breath Patient had a previous reaction to influenza vaccination with shortness of breath
Diagnostic Lab Data: BMP, CBC w/diff, trop/myoglobin x2, TSH, Free T4, Chest X-ray (all ordered 12/22/20)
CDC Split Type:
Write-up: Patient experienced bronchospasm with coughing and tongue itching approximately 10 minutes after the injection. |
|
| VAERS ID: |
907101 (history) |
| Form: |
Version 2.0 |
| Age: |
41.0 |
| Sex: |
Female |
| Location: |
Maine |
| Vaccinated: | 2020-12-22 |
| Onset: | 2020-12-22 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-22 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL1284 / 1 |
RA / IM |
Administered by: Work Purchased by: ?
Symptoms: Chest X-ray,
Cough,
Hyperhidrosis,
Nausea,
Palpitations,
Speech disorder
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (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), Hypoglycaemia (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, ? days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: SIngulair, advair, Duonebs, dupixent, albuterol, zyrtec, chlorpheniramine; wellbutrin, Sertraline;
Current Illness: had been feeling slightly under the weather two weeks ago; no current asthma exacerbation, but has very labile asthma
Preexisting Conditions: Sleep apnea on CPAP eosinophilic asthma on multiple controller meds environmental allergies obesity
Allergies: Anaphylaxis hx to NSAIDS; hs of environmental allergies, and reaction to latex
Diagnostic Lab Data: 12/22/20 - CXR ordered - results not currently available
CDC Split Type:
Write-up: patient felt slightly nauseated at 10 minutes after injection, then developed slight sweating; BP 160/81; 83 at 5:45 and then 158/87 with HR 82 at 5: 52 pm. Her lungs were clear, she was speaking in full sentences and was denying any chest pressure, her usual sense of asthma exacerbation. At 6:05 it was 164/83 with HR 79 and patient developed a dry cough; we decided to have her wait just a bit longer, then cough worsened, so at 6:25, decision was made to have patient seen in ER for further assessment, and en route in wheelchair to ER the dry cough became persistent, spasmodic and patient was unable to speak. Epi-Pen was injected in right mid thigh, and patient transported to ED urgent eval. She noted immediate palpitations, and slight improvement of breahting, was able to speak in four word sentences. On arrival to the ED, patient was administered Duonebs, Albuterol neb, IV Benedryl, IV Solumedrol; CXR was obtained, with results pending. Patient was sent to observation for ongoing monitoring and assessment of breathing. at 6:30 PM in the ER, she |
|
| VAERS ID: |
907330 (history) |
| Form: |
Version 2.0 |
| Age: |
50.0 |
| Sex: |
Female |
| Location: |
Arizona |
| Vaccinated: | 2020-12-22 |
| Onset: | 2020-12-22 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-22 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
011J20A / 1 |
LA / SYR |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
011J20A / 1 |
LA / SYR |
Administered by: Private Purchased by: ?
Symptoms: Abdominal discomfort,
Abdominal pain,
Dizziness,
Dyspnoea,
Headache,
Hyperhidrosis,
Hyperventilation,
Rash macular,
Tremor,
Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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: Flexeril, Advil, Protonix, Estrace, Vivelle DOT Norco PRN
Current Illness: No
Preexisting Conditions: Mild Osteopenia, GERD, Anemia,
Allergies: Reglan - anaphylaxis
Diagnostic Lab Data: 12/22 ED administrated PEPCID, ZOFRAN, Prednisone 60 mg, and Ativan 1mg IV.
CDC Split Type:
Write-up: Employee presented to COVID Clinic for Moderna COVID 19 vaccination 1st dose. Given to left arm. Left clinic prior to completing 15 minute observation time and told an MA in waiting area that she felt ill ot her stomach and having trouble taking deep breaths. Employee found in nearby Bathroom sitting on the floor, she had vomited, reported she was lightheaded, couldn''t breath, shaking, abdominal discomfort sweating, attempted to move employee to wheelchair, did respond well to transfer to Wheelchair, She reported symptoms worsening: HA, abdominal pain and developed blotchy skin, hyperventilating, and dizzy. CODE Blue called, patient given Epinephrine injection 0.5mg patient sent to ER |
|
