|
| VAERS ID: |
902557 (history) |
| Form: |
Version 2.0 |
| Age: |
32.0 |
| Sex: |
Female |
| Location: |
Alaska |
| 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 |
EK5730 / 1 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Blood glucose normal,
Blood test,
Dyspnoea,
Erythema,
Flushing,
Hyperhidrosis,
Pulse abnormal,
Tunnel vision
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Retinal disorders (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Nuvaring
Current Illness: none
Preexisting Conditions: low blood sugar, low blood pressure
Allergies: None
Diagnostic Lab Data: ED visit, blood draw, monitoring - 12/15/20
CDC Split Type:
Write-up: 1750- IM injection ot R Deltoid. She was sitting, and felt short of breath without wheeze or tightness in the chest or throat. She stood up, and then felt tunneling. Assisted to chair and floor. Pulse weak, skin flushed, sweating on torso. Face and Neck remained flushed and red. She refused epi at first. So we gave her benedryll 25 mg po with apple juice. She said she just had a big meal 30 min prior, but we checked her blood sugar- it was 85. 10 min after the first SOB feeling, it returned. BP was recorded as 160/100. |
|
| VAERS ID: |
902758 (history) |
| Form: |
Version 2.0 |
| Age: |
43.0 |
| Sex: |
Male |
| Location: |
Alaska |
| 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: Abnormal sensation in eye,
Blood test,
Dizziness,
Dry mouth,
Euphoric mood,
Periorbital swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Corneal disorders (broad), Vestibular disorders (broad), Periorbital and eyelid disorders (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: MVI- generic brand
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: blood drawn. un sure of test ordered.
CDC Split Type:
Write-up: @ ~5 min felt cotton mouth. Got up to ask if he could go early. Then at 10 min post injection, felt eyes feeling weird and he felt "high". As in lightheaded. @ 10 min, skin surrounding the eyes are puffy. Given 25 mf benedryl. No immediate SOB or wheeze. No lip or mouth or throat swelling. Taken to ED. Given IM epi 1:1000 0.3ml. Pepcid and more benedryll PO. |
|
| VAERS ID: |
902837 (history) |
| Form: |
Version 2.0 |
| Age: |
29.0 |
| Sex: |
Female |
| Location: |
Alaska |
| 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 |
- / IM |
Administered by: Private Purchased by: ?
Symptoms: Anxiety,
Dysphagia,
Tearfulness
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Depression (excl suicide and self injury) (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:
Write-up: Patient feeling very anxious before and after vaccination. Described having difficulty swallowing water shortly (~15 min) post vaccination. Patient was tearful but breathing normally. Walked under her own power from the pharmacy down to the Emergency Room for anxiety over anaphylaxis. Given dose of Vistaril in ER. |
|
| VAERS ID: |
902839 (history) |
| Form: |
Version 2.0 |
| Age: |
58.0 |
| Sex: |
Female |
| Location: |
Alaska |
| 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: Injection site pain,
Injection site swelling
SMQs:, 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:
Other Medications: None
Current Illness: None
Preexisting Conditions: Colitis secondary to possible Crohn''s disease, Inflammatory Polyarthropathy
Allergies: Adhesive Bandages, Bactrim abx
Diagnostic Lab Data: None
CDC Split Type:
Write-up: Local pain and swelling of the injection site |
|
| VAERS ID: |
902841 (history) |
| Form: |
Version 2.0 |
| Age: |
44.0 |
| Sex: |
Female |
| Location: |
Alaska |
| 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: Injection site pain,
Injection site swelling
SMQs:, 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:
Other Medications: None
Current Illness: None
Preexisting Conditions: Allergic Rhinitis, Anxiety, Migraine with Aura, Obesity, PTSD, Sleep Apnea, Subclinical Hypothyroidism, Tobacco Use
Allergies: Sertraline, Penicillins -- described as mild rash only
Diagnostic Lab Data: None
CDC Split Type:
Write-up: Local Pain and swelling of the injection site |
|
| VAERS ID: |
903123 (history) |
| Form: |
Version 2.0 |
| Age: |
37.0 |
| Sex: |
Female |
| Location: |
Alaska |
| 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 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Activated partial thromboplastin time shortened,
Alanine aminotransferase normal,
Anion gap,
Aspartate aminotransferase normal,
Basophil count normal,
Basophil percentage decreased,
Blood albumin normal,
Blood alkaline phosphatase normal,
Blood bilirubin normal,
Blood calcium normal,
Blood chloride normal,
Blood glucose normal,
Blood magnesium normal,
Blood osmolarity decreased,
Blood potassium decreased,
Blood sodium normal,
Blood urea nitrogen/creatinine ratio,
Blood urea normal,
C-reactive protein increased,
Chest discomfort,
Dizziness,
Dyspnoea,
Eosinophil count normal,
Eosinophil percentage decreased,
Fibrin D dimer,
Glomerular filtration rate decreased,
Haematocrit normal,
Haemoglobin normal,
Immature granulocyte count increased,
Injection site pain,
International normalised ratio normal,
Lymphocyte count normal,
Lymphocyte percentage,
Mean cell haemoglobin concentration decreased,
Mean cell haemoglobin normal,
Mean cell volume normal,
Mean platelet volume increased,
Monocyte count normal,
Monocyte percentage,
N-terminal prohormone brain natriuretic peptide normal,
Neutrophil count normal,
Neutrophil percentage,
Palpitations,
Platelet count normal,
Protein total normal,
Rash,
Rash erythematous,
Red blood cell count normal,
Red blood cell sedimentation rate increased,
Red cell distribution width normal,
SARS-CoV-2 test negative,
Troponin T normal,
White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Anaphylactic reaction (narrow), Haematopoietic leukopenia (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Hyponatraemia/SIADH (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Chronic kidney disease (broad), Hypersensitivity (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (narrow), COVID-19 (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: Eliquis, Bumetanide
Current Illness: none
Preexisting Conditions: Pulmonary Hypertension Obesity Li-Fraumeni Syndrome H/o Breast Cancer
Allergies: Latex, Propofol, Nickel, Almonds
Diagnostic Lab Data: WBC 9.88 HGB 14.4 HCT 40.8 Platelet Count 292 RBC 4.81 MCV 84.8 MCH 29.9 MCHC 29.9 RDW 12.5 MPV 10.8 Sedimentation Rate 37 Diff Absolute Neutrophils 6.44 Absolute Imm. Granulocyte 0.01 Absolute Lymphocytes - CBC 2.94 Absolute Monocytes - 0.38 Absolute Eosinophils - 0.08 Absolute Basophils - 0.03 Neutrophils 65.2 % Immature Granulocyte 0.1% Lymphocytes 29.8% Monocytes 3.8% Eosinophils 0.8% Basophils 0.3% Coagulation Prothrombin Time 9.8 sec INR 1.0 Partial Thromboplastin Time 26.4 sec D-DIMER,QUANT 0.67mg/L ROUTINE CHEMISTRY NT-proBNP 29 BUN/Creatinine Ratio 11.4 Osmolality Calculated 277 GFR (estimated) 67 Sodium 139 Potassium 3.0 Chloride 98 CO2 30 BUN 10.7 Creatinine 0.94 Glucose Level 100 Calcium 9.5 Magnesium 1.9 Protein,Total 7.4 Albumin 4.5 AST (SGOT) 18 ALT (SGPT) 24 Alkaline Phosphatase 94 Bilirubin, Total 0.8 CRP, High-Sensitivity 1.72 Anion Gap 14 CARDIAC ISOENZYMES Troponin T <0.01 Molecular Diagnostics SARS-CoV-2 - negatieve
CDC Split Type:
Write-up: About 5 minutes after the vaccine developed chest tightness, increased work of breathing, palpitations and severe dizzyness. Transferred to the ED where i received oxygen, IV benadryl, IV fluids and monitoring. Released after about 4 hours and continue to take benadryl 50 mg PO q 4 hours. Also developed red facial rash (unknown time) Pain at injection site began the morning after the injection. |
|
| VAERS ID: |
903132 (history) |
| Form: |
Version 2.0 |
| Age: |
40.0 |
| 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 |
EK5730 / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Throat tightness,
Wheelchair user
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (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: Influenza vaccine containing eggs
Other Medications: Amlodipine 2.5 mg daily Hydrochlorothiazide 37.5 mg daily Losartan 50 mg bid Metoprolol 50 mg daily Albuterol inhaler as needed
Current Illness: None
Preexisting Conditions: Hypertension h/o LTBI (treated)
Allergies: Chicken, reaction throat tightness Chocolate, throat tightness Egg, throat tightness Shellfish, rash and throat tightness
Diagnostic Lab Data:
CDC Split Type:
Write-up: 40 year female received Pfizer-BioNTech COVID-19 Vaccine today Patient reported prior h/o severe allergic reaction to influenza vaccine with eggs preservative. She has received flu vaccine w/o egg w/o problem. Due to her prior history of severe allergic reaction/ anaphylaxis to another vaccine, in this case flu vaccine with eggs, we should proceed with caution. She was told we could defer vaccination until more information becomes available. She opted to proceed with receiving Pfizer-BioNTech COVID-19 Vaccine and be observed for 30 minute observation period. Patient developed throat tightening approximately 20 minutes after vaccination. She received EpiPen within 1 minute of symptoms and was sent to ER immediately in wheelchair by nursing staff. Patient was evaluated in ED and was hemodynamically stable. She was given IV benadryl and was stable throughout observation |
|
| 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: |
903224 (history) |
| Form: |
Version 2.0 |
| Age: |
57.0 |
| 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 |
EK5730 / 1 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Flushing,
Heart rate increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypersensitivity (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: unknown
Current Illness: none
Preexisting Conditions: obesity, cardiac disease with internal monitor/defibrillator
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:
Write-up: Heart rate increase, flushed for about 20 minutes. She has an internal monitor/defibrillator. States "it feels like when they do a dvice check." |
|
| VAERS ID: |
903235 (history) |
| Form: |
Version 2.0 |
| Age: |
38.0 |
| 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 |
EK5730 / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Feeling cold,
Flushing,
Heart rate increased,
Paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Hypersensitivity (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: beta blocker
Current Illness: none
Preexisting Conditions: obesity, immunocompromised, heart condition
Allergies: adhesives
Diagnostic Lab Data: Pulse oximetry monitoring until recovered
CDC Split Type:
Write-up: elevated heart rate 102, flushed, cold, tingly fingertips |
|
