|
| VAERS ID: |
903159 (history) |
| Form: |
Version 2.0 |
| Age: |
30.0 |
| Sex: |
Female |
| 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 |
EK5730 / 1 |
- / IM |
Administered by: Private Purchased by: ?
Symptoms: Blood pressure increased,
Heart rate increased,
Palpitations
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypertension (narrow), Cardiomyopathy (broad), Dehydration (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: 1450 COVID19 vaccine given. 1503 Patient verbalized a racing heartbeat. 1504 Vital signs obtained, BP & HR were elevated. 1507 Physician paged. 1509 Patient reports feeling much better. 1511 Physician arrived to evaluate. 1516 Patient no longer had symptoms. Vital signs improving. Verbalized understanding to seek medical attention if symptoms reoccur or new symptoms begin. Patient left. |
|
| VAERS ID: |
903160 (history) |
| Form: |
Version 2.0 |
| Age: |
34.0 |
| Sex: |
Female |
| Location: |
Alabama |
| 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 |
EH9899 / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Fatigue,
Impaired work ability,
Migraine,
Nausea,
Photophobia
SMQs:, Acute pancreatitis (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cymbalta 60 mg 1 BID; Propranolol la 120 mg 1/daily; Vyvance 70 mg 1/daily; topomax 200 mg @ bedtime
Current Illness: n/a
Preexisting Conditions: Migraines, history; ADHD, Anxiety, Asthma
Allergies: Bactrum, Wasps
Diagnostic Lab Data: N/A
CDC Split Type: vsafe
Write-up: Dr.; the following day 12/16/2020, I woke up feeling more fatigue then usual with a migraine. Severe with nausea and light sensitivity. AE occurred about 4 hours. Resolved with Advil and Zofran. Missed work 12/16/2020. 12/17/2020 feel back to normal |
|
| VAERS ID: |
903161 (history) |
| Form: |
Version 2.0 |
| Age: |
49.0 |
| Sex: |
Female |
| 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 |
EK5730 / 1 |
LA / IM |
Administered by: Unknown Purchased by: ?
Symptoms: Circumoral swelling,
Oropharyngeal discomfort
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Haemodynamic oedema, effusions and fluid overload (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Augmentin
Diagnostic Lab Data:
CDC Split Type:
Write-up: Sensation of swelling around the mouth and throat felt funny |
|
| VAERS ID: |
903162 (history) |
| Form: |
Version 2.0 |
| Age: |
51.0 |
| Sex: |
Female |
| Location: |
Kansas |
| 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 |
EH9899 / 1 |
LA / IM |
Administered by: Public Purchased by: ?
Symptoms: Hypersensitivity,
Paraesthesia oral,
Swollen tongue
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Acyclovir 800 mg Oral 2 TIMES DAILY Patient taking differently: Take 800 mg by mouth as needed. amLODIPine Besylate 2.5 mg Oral DAILY Atenolol 25 MG TAKE ONE TABLET BY MOUTH EVERY DAY prn Calcium Carbonate-Vitamin D 500-400 MG-UNIT Or
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: Allergies as of 12/17/2020 Reviewed by RN on 12/15/2020 Updated Reaction Type Reactions Bactrim [sulfamethoxazole-trimethoprim] 10/17/2018 1:14 PM Other (See Comments) Causes Acute Kidney Injury Covid-19 (mrna) Vaccine 12/17/2020 12:21 PM Allergy Other (See Comments) Tingling of lips and tongue Decadron [dexamethasone] 01/11/2020 11:28 AM Palpitations Multiple PVCs
Diagnostic Lab Data:
CDC Split Type:
Write-up: Allergic reaction to vaccine +1 more Dx Referred by MD Reason for Visit Progress Notes PA-C (Physician Assistant) ? ? Physician Assistant Cosign Needed Patient was seen at COVID Vaccine Clinic today for her first dose of the COVID 19 vaccination. She denied any history of previous adverse reactions to vaccines. She was given the Pfizer-Biontech (lot: EH9899) vaccination in the left deltoid muscle. During her 15 minute waiting period after the injection, the patient began to experience oral tingling (upper lip and then into the lower lib) It then progressed to the tongue and she reported tingling to the tip of the tongue and further back to the middle of tongue. She thought there might be some mild swelling to the tip of the tongue. She denied rash, hives, welts, difficulty breathing, difficulty swallowing, wheezing, throat tightness, hoarseness, stridor, itching, lightheadedness, dizziness, facial swelling and lip swelling. This Staff member was notified of patient reaction and she was then assessed in the emergency bay area. PMH: Hx hypertension but did not take her medication today. Patient had recovered from the COVID-19 virus about 2 weeks ago. Vitals Time 1130 BP 170/90 HR 86 s/r RR 14 nl O2 97 % Physical Exam Constitutional: She is oriented to person, place, and time. She appears well-developed and well-nourished. No distress. HENT: Head: Normocephalic and atraumatic. Right Ear: Hearing and external ear normal. Left Ear: Hearing and external ear normal. Eyes: Conjunctivae are normal. Right eye exhibits no discharge. Left eye exhibits no discharge. No scleral icterus. Neck: Normal range of motion. Cardiovascular: Normal rate, regular rhythm and normal heart sounds. Pulmonary/Chest: Effort normal and breath sounds normal. No stridor. No respiratory distress. She has no wheezes. She has no rales. Musculoskeletal: Normal range of motion. Neurological: She is alert and oriented to person, place, and time. No sensory deficit. Gait normal. Skin: Skin is warm and dry. She is not diaphoretic. Psychiatric: She has a normal mood and affect. Her behavior is normal. Judgment and thought content normal. Cognition and memory are normal. Vitals reviewed. Treatment included antihistamines. Patient was given 50 mg of benadryl at 1138. Vitals Time 1147 BP 160/100 HR 90 S/R RR 14 nl O2 98% Response to care: Patient states the upper lip resolved but the lower lip and tongue sensations remained but did not worsen. Patient was recommended to go to the hospital given her sudden response with concern of tongue swelling. Patient did agree to this. COVID staff was made aware that the patient would be leaving her SUV in the parking lot. Patient was transfer by Response team to the hospital at 11:53 AM. |
|
| VAERS ID: |
903163 (history) |
| Form: |
Version 2.0 |
| Age: |
32.0 |
| Sex: |
Female |
| Location: |
Maine |
| 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: Cranial nerve disorder,
Nerve conduction studies abnormal,
Paraesthesia,
Paraesthesia oral
SMQs:, Peripheral neuropathy (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Immune-mediated/autoimmune disorders (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Singulair
Current Illness: None
Preexisting Conditions: Asthma
Allergies: None
Diagnostic Lab Data: None
CDC Split Type: vsafe
Write-up: Pt underwent 15 minutes observation and felt fine during that time, while walking back to work on the way to work unit noticed tingling on the L side of her lower lip and a few inches back along jaw. It persisted so she returned to the vaccine clinic for evaluation. She was evaluated by a physician and had a normal cranial nerve and motor exam other than diminished sensation CN5- no change in appearance of lip. There was no other reaction at vaccination site or change in symptoms during a further 30 minute observation period. She was released back to work. Checkin after a few hours the tingling had improved. |
|
| VAERS ID: |
903165 (history) |
| Form: |
Version 2.0 |
| Age: |
35.0 |
| Sex: |
Female |
| Location: |
Texas |
| 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 |
EH9899 / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Chills,
Fatigue,
Pain
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:
Other Medications: Adult Multi vitamin, Vitamin D
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data:
CDC Split Type: vsafe
Write-up: On the night 12/15 exp body aches typically how you feel when having a virus, no fever, no gi symptoms. The following day I had fatigue and one point had chills, body aches. Then took Motrin on night of 12/16 and felt better on 12/17. |
|
| VAERS ID: |
903167 (history) |
| Form: |
Version 2.0 |
| Age: |
43.0 |
| Sex: |
Female |
| Location: |
Virginia |
| 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 |
EH9899 / 1 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Asthenia,
Cold sweat,
Dizziness,
Fasting,
Feeling cold
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (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? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: Band-aids
Diagnostic Lab Data: N/A
CDC Split Type:
Write-up: Began to feel weak, felt as though going to faint, became cool and clammy, BP 100/70 P 46, O2 Sat 100% on room air, no loss of consciousness. Taken to ED - noted patient did not eat prior to getting the vaccine |
|
| VAERS ID: |
903169 (history) |
| Form: |
Version 2.0 |
| Age: |
49.0 |
| Sex: |
Female |
| Location: |
Wisconsin |
| 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 / UNK |
- / - |
Administered by: Private Purchased by: ?
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: unknown
Preexisting Conditions:
Allergies: Walnuts, decadron
Diagnostic Lab Data:
CDC Split Type:
Write-up: Light headed, felt faint. Vitals remained stable. Did need to lay down for approximately 30 min. then sent to ED for evaluation |
|
| VAERS ID: |
903170 (history) |
| Form: |
Version 2.0 |
| Age: |
52.0 |
| Sex: |
Female |
| Location: |
Texas |
| 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 |
EK5730 / 1 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Fatigue,
Headache,
Injection site pain,
Pain,
Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
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: She gets the same adverse events every month when she takes above vaccine.
Other Medications: Xoliar 150ng 1 a month, Vascepa 1 gm 2 x a day, Gemfibrozil 600mg 2xday, hydrochlorizide 12.5 mg 1xday, metoprolol 25mg 1xday
Current Illness: N/A
Preexisting Conditions: Hives, arthritis, back
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type: vsafe
Write-up: I had pain at the injection site, swollen, body aches, and headache. It eventually just went away on its own. Did not take anything for it. Arm feels better after using it. Now I am just tired. |
|
| VAERS ID: |
903174 (history) |
| Form: |
Version 2.0 |
| Age: |
27.0 |
| Sex: |
Male |
| Location: |
West Virginia |
| Vaccinated: | 2020-12-16 |
| Onset: | 2020-12-17 |
| 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: Chills,
Headache,
Pain in extremity
SMQs:, Tendinopathies and ligament 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? No
Hospitalized? No
Previous Vaccinations: arm soreness
Other Medications: None
Current Illness:
Preexisting Conditions: Mild Intermittent Asthma
Allergies: Shellfish, cockroach
Diagnostic Lab Data:
CDC Split Type:
Write-up: On day after vaccination: Left arm soreness, chills, headaches |
|
