|
| VAERS ID: |
903191 (history) |
| Form: |
Version 2.0 |
| Age: |
47.0 |
| Sex: |
Female |
| Location: |
Nebraska |
| Vaccinated: | 2020-12-15 |
| Onset: | 2020-12-15 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Arthralgia,
Chills,
Cold sweat,
Diarrhoea,
Fatigue,
Headache,
Hyperhidrosis,
Injection site pain,
Myalgia,
Pyrexia,
Rhinorrhoea
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D 4000mg daily, pentoprozol 400mg daily, metaformin 500mg daily, centroid 105mg daily, zyrtec OTC/daily
Current Illness: None
Preexisting Conditions: hypothyroidism, gerd, chronic joint pain, pre diabetic
Allergies: antiobiotics (sulphur, peniciliin, keflex, codeine, percocet and aspirin)
Diagnostic Lab Data: No
CDC Split Type: vsafe
Write-up: Within about an hour headache and mild pain at the injection site, around 4:30/5PM all other symptoms hit: chills, fever, fatigue, runny nose and diarrhea, joint and muscle pain, very sweaty and clammy skin |
|
| VAERS ID: |
903192 (history) |
| Form: |
Version 2.0 |
| Age: |
48.0 |
| Sex: |
Female |
| Location: |
South Carolina |
| Vaccinated: | 2020-12-17 |
| Onset: | 2020-12-17 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / UNK |
- / - |
Administered by: Private Purchased by: ?
Symptoms: Dyspnoea,
Paraesthesia oral,
Pharyngeal paraesthesia,
Pharyngeal swelling,
Swollen tongue
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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)
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
Previous Vaccinations:
Other Medications: Yes
Current Illness: None
Preexisting Conditions: Yes
Allergies: Yes
Diagnostic Lab Data:
CDC Split Type:
Write-up: Paresthesias of lateral tongue and throat, subjective swelling of tongue and throat, subjective shortness of breath |
|
| VAERS ID: |
903193 (history) |
| Form: |
Version 2.0 |
| Age: |
56.0 |
| Sex: |
Female |
| Location: |
Michigan |
| Vaccinated: | 2020-12-15 |
| Onset: | 2020-12-16 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EM9899 / 1 |
RA / IM |
Administered by: Work Purchased by: ?
Symptoms: Fatigue,
Headache
SMQs:
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
Previous Vaccinations: allergy shot in 2016
Other Medications: Wellbutrin, Lexapro, xolair
Current Illness: none
Preexisting Conditions: allergies, asthma
Allergies: sulfa causes hives and swelling
Diagnostic Lab Data: None
CDC Split Type: vsafe
Write-up: Caller stated that headaches occurred at 12 in the afternoon and fatigue set in through out the day. Caller took Tylenol and Advil with no relief. Caller stated 12/17/20 headache and fatigue went away. |
|
| VAERS ID: |
903194 (history) |
| Form: |
Version 2.0 |
| Age: |
57.0 |
| Sex: |
Male |
| Location: |
Unknown |
| Vaccinated: | 2020-12-17 |
| Onset: | 2020-12-17 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EJ1685 / 2 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Product preparation issue
SMQs:, Medication errors (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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: not at this time
CDC Split Type:
Write-up: Patient may have received undiluted Pfizer COVID-19 vaccine 0.3 ml= ~120 mcg |
|
| VAERS ID: |
903195 (history) |
| Form: |
Version 2.0 |
| Age: |
27.0 |
| Sex: |
Female |
| Location: |
D.C. |
| Vaccinated: | 2020-12-16 |
| Onset: | 2020-12-16 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Chills,
Fatigue,
Headache,
Nausea,
Pain,
Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Anxiety
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type: vsafe
Write-up: Headache , fever 100.8, chills, Fatigue, body ache . Nausea |
|
| VAERS ID: |
903197 (history) |
| Form: |
Version 2.0 |
| Age: |
33.0 |
| Sex: |
Female |
| Location: |
Alaska |
| Vaccinated: | 2020-12-17 |
| Onset: | 2020-12-17 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EJ1685 / 1 |
LA / IM |
Administered by: Work Purchased by: ?
Symptoms: Dysphonia,
Rash,
Swollen tongue,
Tachycardia,
Throat irritation
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Benadryl 25mg 1hr before vaccine
Current Illness: no
Preexisting Conditions: no
Allergies: no known
Diagnostic Lab Data: none at this time
CDC Split Type:
Write-up: Swollen tongue, scratchy throat, rash, tachycardia, and raspy voice |
|
| VAERS ID: |
903198 (history) |
| Form: |
Version 2.0 |
| Age: |
66.0 |
| Sex: |
Male |
| Location: |
Colorado |
| Vaccinated: | 2020-12-15 |
| Onset: | 2020-12-16 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Abdominal pain,
Body temperature increased,
Chills,
Fatigue
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? No
Previous Vaccinations: Had flu shot and felt like he had the flu for about a day.
Other Medications: Eliquis 5mg 2xday, Dystolic 5mg daily, Mobic 15mg 1xday, Prednisone 10mg 1xday, Spireia (inhaler) 2x day, Breztri inhaler 2 puffs x2 day, Trimidol 2x2a day, Methocarbinal 750mg 1xday, Tizanadine 2mg at pm, Ropirinole .25 mg xpm, Oxybution 1
Current Illness: NA
Preexisting Conditions: Aorita value replacement and repair 2009, Atrilfibulation, COPD, MS,
Allergies: IV forms of phenergen, Inatsine
Diagnostic Lab Data: N/A
CDC Split Type: vsafe
Write-up: Morning after he got the shot....Wave of severe fatigue, had to lay down as he thought he would fall over. Temperature went up a 1/2 degree celius. Went back down later that day. 12/17/2020 2:34 am he woke up with rigors and chills, went away in 3-4 min. Had abdominal pain later during the day.N |
|
| VAERS ID: |
903199 (history) |
| Form: |
Version 2.0 |
| Age: |
52.0 |
| Sex: |
Female |
| Location: |
Louisiana |
| Vaccinated: | 2020-12-16 |
| Onset: | 2020-12-16 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EK5730 / 1 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Asthma,
Condition aggravated,
Head discomfort,
Ocular discomfort,
Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (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
Previous Vaccinations:
Other Medications: Insulin, protonix,
Current Illness: None
Preexisting Conditions: Diabetes type 2, asthma
Allergies: Bactrim, aspirin
Diagnostic Lab Data: None, I took Tylenol, motrin, Benadryl and my asthma inhaler. An hour later all symptoms were gone
CDC Split Type:
Write-up: 2 1/2 hours after the shot, I felt pressure building in my head, my eyes felt bulging, my throat felt tight, and I started having an asthma attack |
|
| VAERS ID: |
903200 (history) |
| Form: |
Version 2.0 |
| Age: |
39.0 |
| Sex: |
Female |
| Location: |
Texas |
| Vaccinated: | 2020-12-17 |
| Onset: | 2020-12-17 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EK5730 / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Dizziness,
Headache
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Symptoms- light headedness, dizziness while in the 30 minute observation window, EE reports she drank water and immediately felt better. EE also endorses mild HA shortly after. EE endorses symptoms completely resolved by 1:30 pm. Called vaccine support line at approximately 3:43 pm to notify us for our records. |
|
| VAERS ID: |
903201 (history) |
| Form: |
Version 2.0 |
| Age: |
61.0 |
| Sex: |
Male |
| Location: |
Oklahoma |
| Vaccinated: | 2020-12-17 |
| Onset: | 2020-12-17 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EK5730 / 1 |
LA / IM |
Administered by: Public Purchased by: ?
Symptoms: Chest pain
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (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? No
Previous Vaccinations:
Other Medications: lisinopril
Current Illness:
Preexisting Conditions: Aortic Valve Stenosis
Allergies: None
Diagnostic Lab Data:
CDC Split Type: COVID19PfizerBioNTech
Write-up: During COVID vaccine administration being held at Medical Center, vaccine was administered by Health Department staff on 12/17/2. At 1:30 pm, during observation, patient stated he was having mild chest pain that was not there prior to vaccine. Client walked to observation room, blood pressure taken 169/89. Patient rated chest pain 1/10, described it as random sharp pain. In ER observation room, client was offered EKG which was declined. Patient was then offered to check in through ER for monitoring, patient also declined. Continued to monitor patient until 2:00 pm, at which point patient stated chest pain had subsided and he requested to go home to relax. Encouraged to return to ER if chest pain returns. |
|
