|
VAERS ID: |
2669001 (history) |
Form: |
Version 2.0 |
Age: |
46.0 |
Sex: |
Male |
Location: |
Unknown |
Vaccinated: | 2021-02-04 |
Onset: | 2021-02-04 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
2001-02-09 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
007M20A / 2 |
LA / IM |
Administered by: Other Purchased by: ? Symptoms: Fatigue,
Headache,
Myalgia,
Pyrexia SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (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? No
Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Headache, Myalgia, Fever, fatigue Narrative: Other Relevant History: |
|
VAERS ID: |
2669769 (history) |
Form: |
Version 2.0 |
Age: |
34.0 |
Sex: |
Female |
Location: |
Unknown |
Vaccinated: | 2021-01-28 |
Onset: | 2021-01-29 |
Days after vaccination: | 1 |
Submitted: |
0000-00-00 |
Entered: |
2011-02-09 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
013L20A / 2 |
LA / IM |
Administered by: Other Purchased by: ? Symptoms: 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: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: body aches, fatigue Narrative: Took OTC Tylenol Other Relevant History: |
|
VAERS ID: |
2672717 (history) |
Form: |
Version 2.0 |
Age: |
49.0 |
Sex: |
Male |
Location: |
Unknown |
Vaccinated: | 2021-01-27 |
Onset: | 2021-01-27 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
2013-02-13 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
- / 2 |
UN / IM |
Administered by: Other Purchased by: ? Symptoms: Headache,
Myalgia SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), 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: Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Headache & Myalgia Narrative: Other Relevant History: |
|
VAERS ID: |
902418 (history) |
Form: |
Version 2.0 |
Age: |
56.0 |
Sex: |
Female |
Location: |
New Jersey |
Vaccinated: | 2020-12-15 |
Onset: | 2020-12-15 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
2020-12-15 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EH9899 / 1 |
LA / IM |
Administered by: Private Purchased by: ? Symptoms: Hypoaesthesia,
Injection site hypoaesthesia SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (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? No
Hospitalized? No
Previous Vaccinations: Other Medications: latex Current Illness: none Preexisting Conditions: none Allergies: none Diagnostic Lab Data: none CDC Split Type:
Write-up: Patient experienced mild numbness traveling from injection site up and down arm that subsided over 20 minutes. |
|
VAERS ID: |
902440 (history) |
Form: |
Version 2.0 |
Age: |
35.0 |
Sex: |
Female |
Location: |
Arizona |
Vaccinated: | 2020-12-15 |
Onset: | 2020-12-15 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
2020-12-15 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EH 9899 / 1 |
LA / SYR |
Administered by: Private Purchased by: ? Symptoms: 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: Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: none CDC Split Type:
Write-up: C/O Headache |
|
VAERS ID: |
902446 (history) |
Form: |
Version 2.0 |
Age: |
55.0 |
Sex: |
Female |
Location: |
West Virginia |
Vaccinated: | 2020-12-15 |
Onset: | 2020-12-15 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
2020-12-15 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EH9899 / 1 |
RA / IM |
Administered by: Other Purchased by: ? Symptoms: Erythema,
Feeling hot,
Flushing SMQs:, Anaphylactic reaction (broad), Hypersensitivity (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? No
Previous Vaccinations: Other Medications: Novasc, Hydrochlorothiazide, synthroid, lisinopril, singulair, MVI, olopatadine drops, prilosec, inderal, crestor, toviaz, ultram Current Illness: none Preexisting Conditions: Hypertension, sleep apnea, hypothyroidism Allergies: Contrast Dye IV contrast, shellfish, strawberry Diagnostic Lab Data: She took Benadryl 50 mg po. No medical tests done. After benadryl, was administered by herself, flushing went away and she felt better. CDC Split Type:
Write-up: felt warm, hot and face and ears were red and flushed. |
|
VAERS ID: |
902464 (history) |
Form: |
Version 2.0 |
Age: |
42.0 |
Sex: |
Male |
Location: |
Louisiana |
Vaccinated: | 2020-12-15 |
Onset: | 2020-12-15 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
2020-12-15 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EH9899 / UNK |
LA / IM |
Administered by: Private Purchased by: ? Symptoms: Dizziness,
Electrocardiogram normal,
Hyperhidrosis,
Laboratory test normal,
Presyncope SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (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: none Current Illness: none Preexisting Conditions: none Allergies: none Diagnostic Lab Data: Basic Chemistry, EKG, and vitals were all normal on 12/15/2020. CDC Split Type:
Write-up: within 15 minutes progressive light-headedness leading to near-syncope and diaphoresis. After 20 minutes symptoms subsided. |
|
VAERS ID: |
902465 (history) |
Form: |
Version 2.0 |
Age: |
60.0 |
Sex: |
Female |
Location: |
Arkansas |
Vaccinated: | 2020-12-15 |
Onset: | 2020-12-15 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
2020-12-15 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EH9899 / 1 |
RA / IM |
Administered by: Public Purchased by: ? Symptoms: Dysgeusia,
Oral pruritus,
Paraesthesia,
Paraesthesia oral,
Parosmia,
Sensory disturbance,
Tremor SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (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? No
Hospitalized? No
Previous Vaccinations: Other Medications: Lisinopril, HCTZ, lipitor, amyitrypline, lexapro, vitamins, Current Illness: Bronchitis, finished prednisone on 12-13-20 Preexisting Conditions: hypertension, fibromyalgia Allergies: Biaxin Diagnostic Lab Data: BP. CDC Split Type:
Write-up: Pt felt wave come over body @ 1218 starting in head and going down. Bad taste in mouth, tingling in body , legs, back , across stomach, BP 150/100 P 120@ 1219, EMS activated. BP 120/80, P 80 Pt alert and oriented, Pt declined transport and Benadryl. Symptoms come and go, pt feels better but then bad taste in mouth starts, shaking of hands, tingling starts again in stomach and back. @ 1300 pt requests Benadryl, 25 mg administered. Pt notified family by phone of circumstances and family in transit.@1324 BP 120/80, P 84, tongue tingling and pt reports smelling chemical smell. @1345 Pt complained of mouth itching, EMS activated and will transport to Medical Center. Pt oriented and transported at @13 |
|
VAERS ID: |
902468 (history) |
Form: |
Version 2.0 |
Age: |
59.0 |
Sex: |
Male |
Location: |
Unknown |
Vaccinated: | 2020-12-15 |
Onset: | 2020-12-15 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
2020-12-15 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EH9899 / 1 |
LA / IM |
Administered by: Private Purchased by: ? Symptoms: Chest discomfort,
Chills,
Defaecation urgency,
Diarrhoea,
Dizziness,
Dyspnoea,
Feeling abnormal,
Flushing,
Presyncope SMQs:, Anaphylactic reaction (narrow), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), 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? No
Previous Vaccinations: vaso-vagal type symptoms, similar presentation 12 hours post vaccine Other Medications: unknown Current Illness: no Preexisting Conditions: unknown Allergies: unknown Diagnostic Lab Data: Trransferred to ED CDC Split Type:
Write-up: Within 1 minute, patient complained of symptoms of lightheadedness, flushing, asked for water. Symptoms persisted, reported vagal and "spacey", vitals were 117/91, HR 67, O2 sat 99% on room air. Reported chest heaviness, shortness of breath and within 5 minutes developed rigors and urge to defecate. 911 called, repeat vital 150/89 HR 113 O2sat 97%, continues to want to defecate. 1 loose BM, transferred to ED |
|
VAERS ID: |
902479 (history) |
Form: |
Version 2.0 |
Age: |
46.0 |
Sex: |
Female |
Location: |
Kansas |
Vaccinated: | 2020-12-14 |
Onset: | 2020-12-14 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
2020-12-15 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
LA / IM |
Administered by: Other Purchased by: ? Symptoms: Chest pain,
Feeling abnormal,
Flushing,
Intensive care SMQs:, Anaphylactic reaction (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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? Yes, 1 days
Extended hospital stay? No Previous Vaccinations: Other Medications: unknown Current Illness: No Preexisting Conditions: unknown Allergies: No Diagnostic Lab Data: Unknown but sent to SICU for monitoring CDC Split Type:
Write-up: rPfizer-BionNTech COVID-19 Vaccine EUA 5-7 minutes after the vaccine Associate stated she did not feel right, mentioned chest pain. "My chest feels funny. It feels like when you have really bad heartburn coming on". "I feel flushed like when you get contrast for a CT". Pulse 90 BP 160/90 checked later 130/90 |
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