|
| VAERS ID: |
904504 (history) |
| Form: |
Version 2.0 |
| Age: |
60.0 |
| Sex: |
Male |
| Location: |
Massachusetts |
| Vaccinated: | 2020-12-19 |
| Onset: | 2020-12-19 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-20 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EJ1685 / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Anaphylactic reaction,
Angioedema,
Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Rosuvastatin, meloxicam, omeprazole, vitamin D
Current Illness: None
Preexisting Conditions: High cholesterol, psoriasis, gerd
Allergies: Shellfish, iodine
Diagnostic Lab Data: None
CDC Split Type:
Write-up: Throat closure (angioedema/anaphylaxis) requiring ambulance transport to Hospital emergency room and stay IV infusion of Benedryl, solumedrol, and Pepcid with excellent results. Observed twelve hours, then discharged. |
|
| VAERS ID: |
904553 (history) |
| Form: |
Version 2.0 |
| Age: |
31.0 |
| Sex: |
Female |
| Location: |
Georgia |
| Vaccinated: | 2020-12-20 |
| Onset: | 2020-12-20 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-20 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EJ1685 / UNK |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Dyspnoea,
Heart rate increased,
Lip swelling,
Paraesthesia
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol, Symbicort, Spiriva
Current Illness: Pink eye
Preexisting Conditions: Asthma
Allergies: Soy
Diagnostic Lab Data:
CDC Split Type:
Write-up: Within a few minutes of taking the vaccine, my lower lip began swelling. I was moved to the emergency department of Hospital and monitored and treated for four hours. Then I was released. At around 1:30 p.m. I felt my skin singling and started having difficulty breathing. Since I was no longer at my work (Hospital) I went to the closest hospital. This reaction was much worse. My husband drove. My heart rate increased. I was released at around 6:30 pm |
|
| VAERS ID: |
904555 (history) |
| Form: |
Version 2.0 |
| Age: |
63.0 |
| Sex: |
Male |
| Location: |
New York |
| Vaccinated: | 2020-12-15 |
| Onset: | 2020-12-17 |
| Days after vaccination: | 2 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-20 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EK 5730 / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Asthenia,
Blood calcium increased,
Blood chloride normal,
Blood creatinine normal,
Blood glucose normal,
Blood lactic acid decreased,
Blood magnesium normal,
Blood potassium normal,
Blood sodium normal,
Blood urea normal,
Carbon dioxide normal,
Chest X-ray normal,
Computerised tomogram head normal,
Diarrhoea,
Electrocardiogram normal,
Electroencephalogram normal,
Fatigue,
Gait disturbance,
Haematocrit normal,
Haemoglobin normal,
Injection site pain,
Magnetic resonance imaging brain normal,
Memory impairment,
Oropharyngeal pain,
Platelet count normal,
Seizure like phenomena,
Syncope,
Vomiting projectile,
White blood cell count increased
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Convulsions (narrow), Pseudomembranous colitis (broad), Parkinson-like events (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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: Bystolic 5mg once a day Prilosec 20mg once a day One a Day multivitamins
Current Illness: No other illnesses at the time of vaccination or one month prior.
Preexisting Conditions: History of hypertension and GERD.
Allergies: No allergies.
Diagnostic Lab Data: 12/17/2020: Na+ 141, K+ 4.4, Cl 101, CO 24, BUN 13, Cr 0.82, Glucose 124, Ca 10.6, Mg 1.7 WBC 11.3, HB 18.1, Hct 52.2, Plts 173 Lactic acid 4.9 (range 0.5-2.2), repeat after hydration 1.1 CXR, CT scan of brain, MRI and E of brain, and EEG all normal
CDC Split Type:
Write-up: I had no reaction following the vaccination. The next day I had very mild soreness at the injection site. The next morning (about 36 hours after the vaccination) I woke up with fatigue and a sore throat. I had breakfast and about 10 minutes later I vomited everything (projectile vomiting, no nausea or abdominal pain). An hour later I had episode of severe watery diarrhea (just one episode). Felt very weak so I decided to sit down, stumbled to a chair, and then proceeded to have a syncopal episode with about 4 minutes of seizure like activity (witnessed, I don''t remember that part). Decided to go to the ER, where I had labs, EKG, CXR, head CT scan, MRI and EEG. I was admitted for 24 hour observation, all the tests were normal. |
|
| VAERS ID: |
904719 (history) |
| Form: |
Version 2.0 |
| Age: |
40.0 |
| Sex: |
Female |
| Location: |
Texas |
| Vaccinated: | 2020-12-16 |
| Onset: | 2020-12-18 |
| Days after vaccination: | 2 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-21 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Angiogram cerebral abnormal,
Central nervous system lesion,
Demyelination,
Dizziness,
Gastrointestinal disorder,
Headache,
Injection site erythema,
Injection site pruritus,
Limb discomfort,
Magnetic resonance imaging brain abnormal,
Neurological symptom,
Palpitations,
Paraesthesia,
Vaccination site swelling
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Vestibular disorders (broad), Immune-mediated/autoimmune disorders (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, 3 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: hydroxyzine, Xyzal, nasal spray, vitamins C, D
Current Illness: vertigo
Preexisting Conditions: asthma
Allergies: benadryl
Diagnostic Lab Data: CTA brain- found infundibulum MRI brain- found lesion and demyelination lumbar puncture- still to be done ** currently admitted in the hospital when this report was given
CDC Split Type:
Write-up: Day 1: palpitations, dizziness Day 2: headache, redness, swelling, itching on vaccination site; GI disturbance Day 3: vaccination arm had paresthesia, heaviness, almost stroke-like symptoms; the symptoms started suddenly ** treated in the ER; IV steroids- for possible allergic reaction; tpa- for the stroke-like signs; halfway through the tpa, I felt an improvement with the arm |
|
| VAERS ID: |
905191 (history) |
| Form: |
Version 2.0 |
| Age: |
86.0 |
| Sex: |
Male |
| Location: |
Michigan |
| Vaccinated: | 2020-12-18 |
| Onset: | 2020-12-18 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-21 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EJ1685 / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: COVID-19,
Dyspnoea,
Hospice care,
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? Yes
Hospitalized? Yes, 2 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin chewable tab, ferrous sulfate tab, memantine tab, and tiotropium inhaler
Current Illness: Inpatient admission 12/3/2020 - 12/7/2020 for acute encephalopathy secondary to acute UTI and suspected pneumonia. Discharged from hospital to long term care on 12/7/2020
Preexisting Conditions: Bladder muscle dysfunction - overactive Alzheimer''s disease History of cerebrovascular accident COPD History of prostate cancer Iron deficiency anemia
Allergies: No known medication, product, or food allergies
Diagnostic Lab Data:
CDC Split Type:
Write-up: Do no suspect that vaccine caused patient condition and resulting inpatient admission. Suspect patient had COVID-19 at time of vaccination, but had not developed symptoms yet. Here is timeline: Patient went to ED on 12-18-2020 at 22:51 with complaint for fever and shortness of breath. Patient ended up testing positive for COVID-19, 12-19-2020 00:09, but was not symptomatic at time of vaccine. As of 12/21/2020 12:04 pm, patient is still inpatient and on comfort care/hospice. |
|
| VAERS ID: |
905320 (history) |
| Form: |
Version 2.0 |
| Age: |
33.0 |
| Sex: |
Male |
| Location: |
New York |
| Vaccinated: | 2020-12-16 |
| Onset: | 2020-12-18 |
| Days after vaccination: | 2 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-21 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Abdominal pain,
Appendicectomy,
Appendicitis,
Computerised tomogram abdomen abnormal,
Laparoscopic surgery,
Scan with contrast abnormal
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), 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: Norvasc 5 mg PO Daily, Vitamin C 1 tab daily
Current Illness: None
Preexisting Conditions: Hypertension, Hyperlipidemia
Allergies: NKDA
Diagnostic Lab Data: CT Scan of Abdomen with contrast on Friday December 16th confirmed early appendicitis
CDC Split Type:
Write-up: severe abdominal pain experience 2 days post vaccination of dose 1 of 2. Diagnoses with early acute appendicitis on Friday December 18th and had a laproscopic appendectomy on Saturday December 19th. |
|
| VAERS ID: |
905345 (history) |
| Form: |
Version 2.0 |
| Age: |
22.0 |
| Sex: |
Male |
| Location: |
Wisconsin |
| Vaccinated: | 2020-12-17 |
| Onset: | 2020-12-20 |
| Days after vaccination: | 3 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-21 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
- / IM |
Administered by: Private Purchased by: ?
Symptoms: Haemorrhage,
Platelet count decreased,
SARS-CoV-2 test negative,
Thrombocytopenia
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (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: None reported by patient
Current Illness: No known past medical history
Preexisting Conditions: None
Allergies: No known allergies
Diagnostic Lab Data: COVID (-) Platelets 2000 cells/mcL
CDC Split Type:
Write-up: Patient received Pfizer COVID 19 vaccine last Thursday 12/17. Admitted today (12/21) with bleeding and low platelet count - working up for ITP, TTP. Given recency of vaccination and no known contributory allergy or medical history, physician thought potentially associated with vaccination. |
|
| VAERS ID: |
905774 (history) |
| Form: |
Version 2.0 |
| Age: |
57.0 |
| Sex: |
Male |
| Location: |
Indiana |
| Vaccinated: | 2020-12-18 |
| Onset: | 2020-12-19 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-21 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EJ1685 / 1 |
UN / IM |
Administered by: Private Purchased by: ?
Symptoms: Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (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: Nurse reports that patient had no problems after receiving vaccination. Patient went home and EMS was called early the next morning and team administered vaccination was contacted physician that the associate works for stating the patient had a heart attack. |
|
| VAERS ID: |
905974 (history) |
| Form: |
Version 2.0 |
| Age: |
44.0 |
| Sex: |
Female |
| Location: |
California |
| Vaccinated: | 2020-12-20 |
| Onset: | 2020-12-20 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-21 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EJ1685 / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Angiogram cerebral normal,
Arteriogram carotid normal,
Blood glucose normal,
Computerised tomogram head normal,
Drug screen positive,
Hemiparesis,
Intensive care,
Magnetic resonance imaging brain normal,
Paraesthesia,
Throat tightness,
Tic,
Urine analysis normal,
White blood cell count increased
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Dyskinesia (broad), Dystonia (broad), Drug abuse and dependence (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hypersensitivity (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, 1 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Nexplanon birth control implant
Current Illness: None
Preexisting Conditions: Thalassemia minor
Allergies: Egg-containing compound Latex Penicillins
Diagnostic Lab Data: 12/20/20 at 1620 Blood glucose = 73 mg/dl 12/20/20 at 1620 White Blood Cells = 10.72 thousand/mm3 12/20/20 at 1758 Urinalysis: negative for infection 12/20/20 at 1758 Urine Toxicology: positive for amphetamine-methamphetamine 12/20/20 at 1636 CT of Head without contrast: negative for bleed 12/20/20 at 2018 CT Angiography of Head and Neck: no significant blockage or stenosis 12/21/20 at 1316 MRI of Brain without contrast: normal evaluation; without any evidence of acute ischemic stroke
CDC Split Type:
Write-up: Left sided weakness of face, arm and left leg, onset 15 minutes after receiving vaccination Brought immediately to ED, subjective feeling of closing of throat. Given IM epinephrine 0.3mg x 1. Upon evaluation in the ED by tele-neurology consult, she received 88.5mg of alteplase on 12/20/20 at 1721 She was admitted to the Intensive Care Unit on 12/20/20 at 2208 Seen by neurology on 12/21/20 at 1227. Evaluation showed weakness on the left side but is noted that it could be effort-related. Neurologist noted that patient was treated with alteplase; CT angiogram showed no significant blockage or stenosis. Noted that this is could be related to a vasovagal effect, psychogenic or an acute ischemic stroke. As of 12/21/20 at 1615, attending provider noted left-sided paresthesia, left-sided tics and possible transient ischemic attack |
|
| VAERS ID: |
906282 (history) |
| Form: |
Version 2.0 |
| Age: |
55.0 |
| Sex: |
Female |
| Location: |
Missouri |
| Vaccinated: | 2020-12-20 |
| Onset: | 2020-12-20 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-21 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EH9899 / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Aphasia,
Dyspnoea,
Hypopnoea,
Intensive care,
Throat clearing,
Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypersensitivity (broad), Respiratory failure (narrow)
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: IVIG, Mestinon, Lisinopril, Immodium, Advil, Imuran, Baclofen
Current Illness:
Preexisting Conditions: Myastheniz Gravis, Multiple Sclerosis, PCOS, HTN
Allergies: IVIG, Tecfideral, Atropine
Diagnostic Lab Data: unknown
CDC Split Type:
Write-up: Given the vaccine at 712 pm on 12/20/20. At approximately 715 pm, she began to clear her throat and then became unable to speak, followed by audible wheezes and short, shallow breaths. At 1923, Epinephrine was administered. At 1928, she was able to speak again and was transported to the ED. The patient reports after arrival to the ER, the symptoms returned. She was given PO Benadryl, followed by IV Benadryl, and then a 2nd dose of Epinephrine. She was admitted to the ICU for observation. |
|
