|
| VAERS ID: |
902672 (history) |
| Form: |
Version 2.0 |
| Age: |
33.0 |
| Sex: |
Female |
| Location: |
Massachusetts |
| Vaccinated: | 2020-12-15 |
| Onset: | 2020-12-15 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-16 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EK5730 / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Erythema,
Joint swelling,
Peripheral swelling,
Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Arthritis (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: alyacen birth control, minocycline, trintellix
Current Illness: none
Preexisting Conditions: NOS hypersomnia, anxiety, exercise induced asthma
Allergies: nickel, metals, environmental weeds grass trees mold mold spores dust dust mites cockroaches feathers
Diagnostic Lab Data: none
CDC Split Type:
Write-up: Left arm swelling of forearm, old L wrist tattoo because raised and lifted out of skin approx 3 mm, whole arm was itching with several red dots; reaction resolved within 8 hours without intervention body wide itching persisting now |
|
| VAERS ID: |
902673 (history) |
| Form: |
Version 2.0 |
| Age: |
38.0 |
| Sex: |
Female |
| Location: |
Colorado |
| Vaccinated: | 2020-12-16 |
| Onset: | 2020-12-16 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-16 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EH9899 / N/A |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Patient had sudden onset of nausea . Patient was laid flat on the floor and given and alcohol. Symptoms resolved and patient was released home. |
|
| VAERS ID: |
902674 (history) |
| Form: |
Version 2.0 |
| Age: |
38.0 |
| Sex: |
Female |
| Location: |
Wyoming |
| Vaccinated: | 2020-12-16 |
| Onset: | 2020-12-16 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-16 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Dizziness,
Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: none
Preexisting Conditions: none
Allergies: Doxycycline
Diagnostic Lab Data: None
CDC Split Type:
Write-up: Patient has a prior anaphylaxis reaction to Doxycycline. 10minutes after immunization, she developed sweaty palms and lightheadedness. No throat swelling or difficulty breathing. Placed supine, BP 160/100, HR 60-70, O2 97% RA. After a period of monitoring the symptoms improved. No intervention given. |
|
| VAERS ID: |
902691 (history) |
| Form: |
Version 2.0 |
| Age: |
39.0 |
| Sex: |
Male |
| Location: |
Unknown |
| Vaccinated: | 2020-12-14 |
| Onset: | 2020-12-01 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-16 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / UNK |
- / - |
Administered by: Private Purchased by: ?
Symptoms: Pain
SMQs:
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: USPFIZER INC2020493763
Write-up: Pain; This is a spontaneous report from a non-contactable physician. A 39-year-old male patient received BNT162B2 (Pfizer-BioNTech COVID-19 mRNA vaccine), via an unspecified route of administration on 14Dec2020 at 12:00 (at the age of 39-years-old) as a single dose for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. On an unknown date in Dec2020, the patient experienced pain. The clinical outcome of the pain was unknown. No follow-up attempts are possible; information about lot number cannot be obtained. |
|
| VAERS ID: |
902706 (history) |
| Form: |
Version 2.0 |
| Age: |
30.0 |
| Sex: |
Female |
| Location: |
Minnesota |
| Vaccinated: | 2020-12-15 |
| Onset: | 2020-12-16 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-16 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EH9899 / 1 |
- / IM |
Administered by: Private Purchased by: ?
Symptoms: Chills,
Nausea,
Pain
SMQs:, Acute pancreatitis (broad), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft, post-natal vitamin, dha, vitamin d
Current Illness: None
Preexisting Conditions: None
Allergies: Dairy, gluten, morphine allergies
Diagnostic Lab Data:
CDC Split Type:
Write-up: Bp of 85/44, nauseous, body aches, chills |
|
| VAERS ID: |
902709 (history) |
| Form: |
Version 2.0 |
| Age: |
33.0 |
| Sex: |
Female |
| Location: |
North Dakota |
| Vaccinated: | 2020-12-15 |
| Onset: | 2020-12-15 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-16 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EH9899 / 1 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Fatigue,
Headache,
Injection site pain,
Malaise
SMQs:, Extravasation events (injections, infusions and implants) (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: Fluvoxamine
Current Illness: NA
Preexisting Conditions: NA
Allergies: NKDA
Diagnostic Lab Data: NA
CDC Split Type: vsafe
Write-up: I worked overnight after getting the vaccine. I felt really tired and came home and slept until 3 pm. When I woke up I had a dull headache and felt crummy. Decided to sleep the remainder of the day but no fever just was fatigued and had a headache. My arm was hurting at the injection site but the pain has sense left and the headache is gone also. |
|
| VAERS ID: |
902720 (history) |
| Form: |
Version 2.0 |
| Age: |
50.0 |
| Sex: |
Male |
| Location: |
New Mexico |
| Vaccinated: | 2020-12-15 |
| Onset: | 2020-12-16 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-16 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / UNK |
- / - |
Administered by: Private Purchased by: ?
Symptoms: Fatigue,
Pain in extremity,
Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Tendinopathies and ligament disorders (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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Write-up: NORMAL ARM PAIN HOWEVER THE FOLLOWING WAS FELT REAL TIRED BARELY ABLE TO STAY AWAKE |
|
| VAERS ID: |
902725 (history) |
| Form: |
Version 2.0 |
| Age: |
80.0 |
| Sex: |
Male |
| Location: |
Virginia |
| Vaccinated: | 2020-12-14 |
| Onset: | 2020-12-16 |
| Days after vaccination: | 2 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-16 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Mobility decreased,
Pain in extremity
SMQs:, Parkinson-like events (broad), Tendinopathies and ligament 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: I take one baby asprin daily, one fish oil pill daily and one vitamin c tablet daily
Current Illness: No illnesses
Preexisting Conditions: No
Allergies: I don''t have any allergies to medications or food.
Diagnostic Lab Data: None
CDC Split Type:
Write-up: I experienced a sore arm and could not lift my arm. |
|
| VAERS ID: |
902728 (history) |
| Form: |
Version 2.0 |
| Age: |
34.0 |
| Sex: |
Female |
| Location: |
Texas |
| Vaccinated: | 2020-12-15 |
| Onset: | 2020-12-16 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-16 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
PAA156057 / 1 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Peripheral swelling,
Product administered at inappropriate site
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Medication errors (narrow)
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: BCPs (birth control pills)
Current Illness: None
Preexisting Conditions: MigRaines as 12/16/20
Allergies: Penicillin + Sulfa
Diagnostic Lab Data: (-)
CDC Split Type:
Write-up: Swelling on arm. Placement lower than deltoid, 4 cm. treated with corticosteroids, antihistamines |
|
| VAERS ID: |
902733 (history) |
| Form: |
Version 2.0 |
| Age: |
55.0 |
| Sex: |
Female |
| Location: |
New York |
| Vaccinated: | 2020-12-16 |
| Onset: | 2020-12-16 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-16 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EK5730 / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Dysgeusia,
Immediate post-injection reaction,
Myalgia,
Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Taste and smell disorders (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), 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: Synthroid
Current Illness:
Preexisting Conditions: Hypothyroidism
Allergies: Laytex, Beestings, Tape
Diagnostic Lab Data: BP 107/70 99% O2 on RA HR 49
CDC Split Type:
Write-up: Pt started to have a metallic taste in her mouth immediately after administration of the Covid-19 vaccine. She started to feel nauseous and myalgias. The patient was seated, given Zofran 4mg once and Benadryl 25 mg once. After 10 min patient was eating juice + crackers. Reports she feels better. A co-worker verbalized he would drive her home, patient agreed. |
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