|
| VAERS ID: |
919376 (history) |
| Form: |
Version 2.0 |
| Age: |
19.0 |
| Sex: |
Female |
| Location: |
Montana |
| Vaccinated: | 2020-12-30 |
| Onset: | 2021-01-02 |
| Days after vaccination: | 3 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-04 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
- / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Limb discomfort,
Limb mass,
Pain of skin,
Skin warm,
Thrombosis,
Ultrasound scan abnormal
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (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: Dasetta 1/35, Bile salts OTC, Proair Inhaler PRN
Current Illness: N/a
Preexisting Conditions: Asthma
Allergies: Penicillin
Diagnostic Lab Data: 1/4/2021 confirmed with ultrasound of lower extremity.
CDC Split Type:
Write-up: Patient received Moderna vaccine, Wednesday 12/30. On Saturday 1/3/2021 patient felt pressure/tightness in lower extremity. When patient touched area, a noticeable ball was felt under the skin, tender to the touch and warm. Patient went into urgent care on Monday 1/4/2021 with a confirmed dx of a superficial blood clot. Unknown etiology of whether this is from current birth control or the COVID19 Moderna vaccine. |
|
| VAERS ID: |
955565 (history) |
| Form: |
Version 2.0 |
| Age: |
19.0 |
| Sex: |
Female |
| Location: |
Ohio |
| Vaccinated: | 2021-01-07 |
| Onset: | 2021-01-14 |
| Days after vaccination: | 7 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-19 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
011L20A / 1 |
LA / IM |
Administered by: Other Purchased by: ?
Symptoms: Abdominal distension,
Activated protein C resistance test positive,
Coagulation test,
Computerised tomogram abdomen,
Constipation,
Deep vein thrombosis,
Electrocardiogram,
Erythema,
Faecaloma,
Flank pain,
Laboratory test,
May-Thurner syndrome,
Oedema peripheral,
Pain in extremity,
Prothrombin level increased,
Thrombectomy,
Urinary retention,
Vascular test,
Venogram,
Venous stent insertion
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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? Yes, 3 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Benztropine Mesylate 1 mg. by mouth twice daily clozapine 50 mg. by mouth daily at 0700 and 1600, 100 mg. daily by mouth at 8 p.m. (200 mg. total daily) Junel 1-20, one tablet by mouth once daily Ativan 0.5 mg. by mouth three times daily
Current Illness: Patient was actively being treated for Bipolar disorder with most recent episode depression, Anxiety disorder, ADHD, Oppositional Defiant disorder, Autism Spectrum Disorder, Fetal Alcohol Syndrome, Intermittent Explosive Disorder, a history of Pseudo-seizures, and insomnia. She has Alopecia Areata, and allergic rhinitis, and constipation. She has a history of left eye strabismus and uses glasses. She has not been acutely ill prior to vaccination.
Preexisting Conditions: See above, history also of right radial neck fracture in 2019 with ORIF repair. Living at Center for behavioral management and stabilization
Allergies: Ideopathic reaction to clonidine and benadryl - Awake for days after use Risperdal causes Aggression No true allergies
Diagnostic Lab Data: Vascular studies venogram with radiology review and interpretation CT of Abd. and Pelvis Left Hip and Pelvis EKG Labs - including coagulation studies Stint insertion into Left Iliac vein
CDC Split Type:
Write-up: One week after the shot (1-14-2021) Patient (19 y.o.)reported side pain and appeared constipated, Laxatives given along with Tylenol, on further assessment Patient was noted to have left leg redness and abdominal fullness. Dr. was updated and we had orders for close monitoring, the next day when she got up, her leg appeared better, and she had passed a small BM, but by lunch she had developed significant pain and edema in her left leg, and the color of her leg was reddened again. She was sent to the emergency room with her symptoms. She was admitted back to our facility yesterday, her diagnoses included Acute provoked left external illiac, femoral, popliteal, and peroneal DVT. Elevated Factor II levels, Elevated APC resistant, May-Thurner Syndrome, history of developmental disabilities, fecal impaction and urinary retention - suspected related to her fecal impaction. Vascular surgery was consulted, and pt. was started on a heparin drip, and mechanical thrombectomy was needed for both legs due to multiple clots. She was started on Eliquis and Plavix, and thigh high compression stockings were ordered, ace wraps being used until these are supplied. Her Fecal impaction was addressed also and the urinary retention resolved. |
|
| VAERS ID: |
1162619 (history) |
| Form: |
Version 2.0 |
| Age: |
18.0 |
| Sex: |
Female |
| Location: |
Nevada |
| Vaccinated: | 2021-03-16 |
| Onset: | 2021-04-01 |
| Days after vaccination: | 16 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-04-02 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN |
- / 1 |
- / IM |
Administered by: Private Purchased by: ?
Symptoms: Angiogram cerebral,
Magnetic resonance imaging head,
Superior sagittal sinus thrombosis
SMQs:, Embolic and thrombotic events, venous (narrow), Central nervous system vascular disorders, not specified as haemorrhagic or ischaemic (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? Yes, ? days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CT angiogram head, MRI brain
CDC Split Type:
Write-up: Superior sagittal sinus thrombosis diagnosed on 4/1/2021. Symptoms started early on April 1, 2021 |
|
| VAERS ID: |
1169265 (history) |
| Form: |
Version 2.0 |
| Age: |
18.0 |
| Sex: |
Female |
| Location: |
Texas |
| Vaccinated: | 2021-02-11 |
| Onset: | 2021-03-22 |
| Days after vaccination: | 39 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-04-05 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EM9809 / 2 |
UN / IM |
Administered by: Pharmacy Purchased by: ?
Symptoms: Anti factor Xa assay normal,
Coagulation factor VIII level increased,
Deep vein thrombosis,
Fibrin D dimer,
Limb discomfort,
Pain in extremity,
Skin tightness,
Thrombosis,
Ultrasound Doppler abnormal
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Cardiomyopathy (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Depo-Provera (started 11/30/20), cholecalciferol, Briviact, diazepam, Diastat PRN, Epidiolex, felbamate, folic acid, Keppra, melatonin, norethindrone, pregabalin, Vitamin B6
Current Illness:
Preexisting Conditions: Cerebral venous sinus thrombosis - onset 7/10/20 after extensive neurosurgery (Resolved on Lovenox x3 months), Vitamin D deficiency Speech delay Cerebral venous sinus thrombosis - Onset: 07/10/2020 Left hemiparesis Generalized convulsive epilepsy Severe myoclonic epilepsy in infancy Menstrual epilepsy Epilepsy Deep venous thrombosis of lower extremity - Onset: 03/23/2021, Left Genetic mutation Constipation Cyst of ovary Oligomenorrhea Sleep disorder Abnormal gait Hemi-neglect Urinary incontinence Gastrostomy present Severe myoclonic epilepsy in infancy, refractory
Allergies: Fosphenytoin, Ketamine (seizure), Benadryl (phlebitis)
Diagnostic Lab Data: 3/24/21 - Anti-Xa=0.53 D-dimer = 3421 Factor VIII assay $g150 3/29/21 Anti Xa = 0.49 Sedated ultrasound - Extensive thrombus is noted extending from external iliac vein to distal femoral vein. Some non-occlusive thrombus also noted in the proximal greater saphenous vein. There appears to be decreased thrombus noted in the popliteal vein with near recanalization as well as in the posterior tibial vein.
CDC Split Type:
Write-up: Acute DVT in left LE. Patient presented to ED on 3/22/21. She had 2 day h/o leg discomfort and leg was taught and painful on the day she went to the ED. Study was limited due to pt lack of cooperation. Lovenox started. |
|
| VAERS ID: |
1200320 (history) |
| Form: |
Version 2.0 |
| Age: |
18.0 |
| Sex: |
Female |
| Location: |
D.C. |
| Vaccinated: | 2021-03-13 |
| Onset: | 2021-03-20 |
| Days after vaccination: | 7 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-04-13 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN |
- / 1 |
LA / SYR |
Administered by: Private Purchased by: ?
Symptoms: Influenza like illness,
Muscle spasms,
Thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Dystonia (broad), Thrombophlebitis (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: Albuterol Sulfate, Tretinoin Cream 0.0025%, Xulane birth control patch
Current Illness: None
Preexisting Conditions: Asthma.
Allergies: None
Diagnostic Lab Data:
CDC Split Type:
Write-up: Flu-like symptoms. Muscle cramping in the left leg. Continuos period with heavy blood clotting. |
|
| VAERS ID: |
1206380 (history) |
| Form: |
Version 2.0 |
| Age: |
19.0 |
| Sex: |
Female |
| Location: |
Texas |
| Vaccinated: | 2021-04-08 |
| Onset: | 2021-04-10 |
| Days after vaccination: | 2 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-04-14 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN |
- / 1 |
RA / SYR |
Administered by: Private Purchased by: ?
Symptoms: Chest X-ray,
Computerised tomogram thorax,
Dyspnoea,
Headache,
Magnetic resonance imaging,
Thrombosis
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Estarylla
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: 4/13/2021: -Chest x-ray -Chest CT -MRI
CDC Split Type:
Write-up: On 4/8/2021 I developed a headache after receiving the Johnson and Johnson vaccine. I took the next few days easy, and laid in bed for the majority of the weekend. On 4/10/2021 I left my residence to get dinner and noticed I was short of breath just walking from the building to my car. The shortness of breath worsened over the next few days. On 4/13/2021 I called a clinic and told them I had been short of breath and they directed me to the ER. I arrived to the ER around 2:30 in the afternoon. They ordered a chest x-ray and ran a test to determine if I could have a blood clot. The test came back with results indicating I could have a blood clot, so they did a chest CT and an MRI. The chest CT showed a blood clot in my left pulmonary artery. They prescribed a blood thinner, told me to stop taking oral birth control, and discharged me. |
|
| VAERS ID: |
1206421 (history) |
| Form: |
Version 2.0 |
| Age: |
17.0 |
| Sex: |
Male |
| Location: |
California |
| Vaccinated: | 2021-03-11 |
| Onset: | 2021-03-14 |
| Days after vaccination: | 3 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-04-14 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EN6204 / 1 |
RA / SYR |
Administered by: Other Purchased by: ?
Symptoms: Blood test abnormal,
Deep vein thrombosis,
Nodule,
Pain in extremity,
SARS-CoV-2 test negative,
Thrombosis,
Ultrasound scan abnormal
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (broad), Tendinopathies and ligament disorders (broad), COVID-19 (broad)
Life Threatening? Yes
Birth Defect? Yes
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: melatonin,
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Ultrasound on 3/18 showed DVT in right calf, and blood panels were also done, covid test was negative. Blood work showed he was positive for heterozygous positivity for Factor11 (prothrombin) gene mutation
CDC Split Type:
Write-up: Blood clot in right calf. Noticed pain and knot in calf on Sunday 3/14/2021. It worsened over the next few days. Went to Urgent care on 3/18 and they sent us straight to ER for Ultrasound. In hospital they found it was a clot identified as deep vein thrombosis, and started a treatment of blood thinner and pain medication. |
|
| VAERS ID: |
1208555 (history) |
| Form: |
Version 2.0 |
| Age: |
18.0 |
| Sex: |
Female |
| Location: |
Unknown |
| Vaccinated: | 2021-04-09 |
| Onset: | 2021-04-12 |
| Days after vaccination: | 3 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-04-14 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN |
- / 1 |
AR / IM |
Administered by: Private Purchased by: ?
Symptoms: Epistaxis,
Thrombosis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (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:
Current Illness: She did have blt turbinate reduction 3 weeks prior to vaccine, but drainage had been clear for $g1 week prior to vaccine. Day after vaccine she had large blood clots from nares
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: multiple large blood clots from her nares on Monday 4/12 |
|
| VAERS ID: |
1220371 (history) |
| Form: |
Version 2.0 |
| Age: |
19.0 |
| Sex: |
Male |
| Location: |
California |
| Vaccinated: | 2021-03-11 |
| Onset: | 2021-03-15 |
| Days after vaccination: | 4 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-04-16 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 2 |
LA / - |
Administered by: Senior Living Purchased by: ?
Symptoms: Axillary pain,
Chest X-ray normal,
Chest pain,
Computerised tomogram thorax,
Electrocardiogram normal,
Heart rate irregular,
Peripheral artery thrombosis,
Ultrasound scan
SMQs:, Embolic and thrombotic events, arterial (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
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: CT chest 3/30- Negative Ultrasound 4/14/21- Thrombosis left brachial vein
CDC Split Type:
Write-up: Pain left axilla developed evening of vaccine given date, next day developed pain over left side chest with fluctuating heart rate. Per patient he went to ERD on 3/15 where he had a chest xray and ekg with normal results, advised to take pain meds and follow up with PCP. On 3/16/21 pt seen via call advised to take anti inflamatories and labs ordered. Follow up OV on 3/22/21 CT chest ordered, prescribed pain med and anti inflammatories. 3/29 follow up visit- symptoms unresolved, 4/5 sympt unresolved, 4/15 4wks post injection sympt continue order Ultra sound left extremity |
|
| VAERS ID: |
1224262 (history) |
| Form: |
Version 2.0 |
| Age: |
19.0 |
| Sex: |
Female |
| Location: |
California |
| Vaccinated: | 2021-03-28 |
| Onset: | 2021-03-30 |
| Days after vaccination: | 2 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-04-18 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
ER8734 / 1 |
LA / OT |
Administered by: Other Purchased by: ?
Symptoms: Bone pain,
Mass,
Pain,
Thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Osteonecrosis (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: USPFIZER INC2021349630
Write-up: strange pain on her left collar bone; going to see someone just in case it''s a blood clot; lump on her collar bone, left collar bone; does hurt a little bit; This is a spontaneous report from a contactable consumer or other non hcp (patient herself). A 19-years-old female patient received bnt162b2 (BNT162B2, Formulation: Solution for injection), dose 1 intramuscularly administered in Arm Left (like the shoulder area) on 28Mar2021 09:00 (Lot Number: ER8734 and Expiry date: unknown) as single dose for covid-19 immunisation. The patient medical history was not reported. There were no concomitant medications. No additional Vaccines administered on same date of the Pfizer suspect. On 30Mar2021, the patient experienced going to see someone just in case it''s a blood clot, lump on her collar bone, left collar bone, does hurt a little bit and on unspecified date strange pain on her left collar bone. 19-year-old female got the first Pfizer Covid vaccine at 9 am on Sunday, March 28 and this morning, she woke up with a strange pain on her left collar bone and there was a lump there, states when she woke up, she noticed a pain, checked in the mirror, she saw on the left side she saw a bump and checked on the right side and didn''t see anything and that''s when she got worried. Caller states she was just calling to report it, she''s worried that it''s a blood clot or something else. Why was the patient taking Pfizer BioNTech COVID Vaccine (Verbatim): she wanted to be vaccinated to protect herself and her community. Caller states she would not like to provide her last name at this time. However, provided her last name initial. She also reports she would not like to provide her address, height, or weight right now. She states she used to volunteer at a hospital. She does not see expiration or NDC number on card she received when she got her vaccine. Caller states she does know that one of her family members has the Factor 5. She is not sure if she has it but would like to be tested for it. The outcome of the event going to see someone just in case it''s a blood clot was recovered, lump on her collar bone, left collar bone and does hurt a little bit was not recovered and strange pain on her left collar bone was unknown. Information on batch/Lot number has been requested. |
|
| VAERS ID: |
1231186 (history) |
| Form: |
Version 2.0 |
| Age: |
18.0 |
| Sex: |
Male |
| Location: |
Tennessee |
| Vaccinated: | 2021-04-05 |
| Onset: | 2021-04-16 |
| Days after vaccination: | 11 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-04-19 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EP7533 / 1 |
- / - |
Administered by: Private Purchased by: ?
Symptoms: Pain,
Pain in extremity,
Thrombosis,
Ultrasound scan abnormal
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Bupropion 150 mg/day Adhansia 45 mg/day Men''s multivitamin
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa drugs
Diagnostic Lab Data: Ultrasound of left leg
CDC Split Type:
Write-up: Approximately 11 days after receiving my first dose, I began feeling dull pain in my left calf. By Saturday, 4/17, the pain was severe enough to warrant a trip to the emergency room. After receiving an ultrasound of my leg, two blood clots were found in my left calf. One fully occluded a vein and another partially occluded a different vein. |
|
| VAERS ID: |
1234443 (history) |
| Form: |
Version 2.0 |
| Age: |
16.0 |
| Sex: |
Female |
| Location: |
Colorado |
| Vaccinated: | 2021-03-31 |
| Onset: | 2021-03-31 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-04-20 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
ER8734 / 1 |
RA / IM |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EW0161 / 2 |
RA / IM |
Administered by: Pharmacy Purchased by: ?
Symptoms: Blood thromboplastin,
Epistaxis,
Full blood count normal,
Thrombosis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Methotrexate
Current Illness:
Preexisting Conditions: JIA and Sjogrens
Allergies:
Diagnostic Lab Data: After dose #1 CBC (normal) and Urinalysis (abnormal- clarity and elevated pH) after dose #2 CBC (normal) PTT and PT. Pediatrician consulting a hematologist
CDC Split Type:
Write-up: After the first dose, mild dizziness and nausea followed by massive inflammation in joints and face, severe fatigue and loss of hearing in right ear. Hearing returned in 3 days, general malaise until a week before 2nd shot when she started having severe bloody noses and EXTREMELY heavy period. After the second dose, 45 minute nose bleed soaked through two wash cloths, so many blood clots it clogged the sink. |
|
| VAERS ID: |
1251532 (history) |
| Form: |
Version 2.0 |
| Age: |
19.0 |
| Sex: |
Female |
| Location: |
Connecticut |
| Vaccinated: | 2021-04-10 |
| Onset: | 2021-04-11 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-04-24 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN |
205A21A / 1 |
RA / IM |
Administered by: Pharmacy Purchased by: ?
Symptoms: Adverse reaction,
Pain in extremity,
Thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (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: Anovera 0.013-0.15 mg / 24 hr ring
Current Illness:
Preexisting Conditions: asthma and anemia
Allergies: no known allergies
Diagnostic Lab Data:
CDC Split Type:
Write-up: Patient stated she needed to go to hospital for adverse reaction of pain in leg. After asking MD to check her leg, they discovered a blood clot per patient. She is now doing well per her. |
|
| VAERS ID: |
1273276 (history) |
| Form: |
Version 2.0 |
| Age: |
19.0 |
| Sex: |
Female |
| Location: |
Illinois |
| Vaccinated: | 2021-04-12 |
| Onset: | 2021-04-24 |
| Days after vaccination: | 12 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-04-30 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN |
206A21A / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Cerebral venous thrombosis,
Venogram abnormal
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (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? Yes, ? days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: levothyroxine 50 mcg tablet (taken for Hashimoto thyroiditis) naproxen 250 mg tablet (taken PRN)
Current Illness:
Preexisting Conditions: Hashimoto thyroiditis
Allergies: no allergies on file
Diagnostic Lab Data: 4/29-MRV Brain without contrast
CDC Split Type:
Write-up: 19 y.o. female with h/o Hashmoto''s thyroiditis now admitted 4/29/2021 with cerebral venous thrombosis. She received J&J COVID vaccine on 4/12. |
|
| VAERS ID: |
1286564 (history) |
| Form: |
Version 2.0 |
| Age: |
19.0 |
| Sex: |
Female |
| Location: |
Maryland |
| Vaccinated: | 2021-03-26 |
| Onset: | 2021-04-02 |
| Days after vaccination: | 7 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-05-04 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
ER8732 / 1 |
LA / IM |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EW0158 / 2 |
RA / IM |
Administered by: Other Purchased by: ?
Symptoms: Deep vein thrombosis,
Hypoaesthesia,
Pain in extremity
SMQs:, Peripheral neuropathy (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad), Sexual dysfunction (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none, no travel
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: L upper extremity ultrasound revealed L DVT in brachial vein and superficial basilic vein. Hematology was consulted and she was started on Xarelto 15mg to be increased to 20mg. She has OP follow up with hematologist
CDC Split Type:
Write-up: She developed pain a week after date of injection, this seemed to get better but then returned again about 2 weeks later. Her L arm pain got progressively worse. She then received the 2nd dose of pfeizer vaccine on 4/19/2021 this time she got it in her R arm because of the pain in her L arm. Her L arm pain got worse to the point she was not able to feel her entire L arm. So she decided to go the ER |
|
| VAERS ID: |
1290426 (history) |
| Form: |
Version 2.0 |
| Age: |
17.0 |
| Sex: |
Male |
| Location: |
Utah |
| Vaccinated: | 2021-04-21 |
| Onset: | 2021-04-21 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-05-05 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Activated partial thromboplastin time,
Angiogram cerebral abnormal,
Anticoagulant therapy,
Arteriogram carotid abnormal,
Blood fibrinogen,
Body temperature increased,
C-reactive protein normal,
Computerised tomogram abnormal,
Computerised tomogram head abnormal,
Computerised tomogram neck,
Deep vein thrombosis,
Epstein-Barr virus antibody,
Full blood count,
Gene mutation identification test,
Headache,
Influenza A virus test,
Influenza virus test,
Intensive care,
International normalised ratio normal,
Localised oedema,
Lymphadenitis bacterial,
Malaise,
Metabolic function test,
Neck pain,
Prothrombin time normal,
SARS-CoV-2 test negative,
Scan with contrast,
Thrombophlebitis,
Transverse sinus thrombosis
SMQs:, Angioedema (broad), Neuroleptic malignant syndrome (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Central nervous system vascular disorders, not specified as haemorrhagic or ischaemic (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypersensitivity (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (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? Yes, ? days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lexapro, Gabapentin
Current Illness: Previously healthy
Preexisting Conditions: Previously healthy
Allergies: NKDA
Diagnostic Lab Data: CT Head and Neck - 4/26: Significant diffuse right-sided deep spatial neck edema. Right-sided adenopathy is present and there is a right level 2 1.8 cm suppurative lymph node or abscess. CTA Head and Neck - 5/4: 1. Deep venous thrombosis involving the left internal jugular vein from the skull base to approximately the level of the hyoid bone. Of note CT of the brain performed the same day shows extension of this thrombus into the transverse sinus. 2. Suppurative lymphadenopathy in the right side of the neck. This was present on the previous study and has decreased slightly in size. 3. No evidence of embolic disease in the visualized portions of the lungs on today?s study. CBC, BMP, PTT, PT, INR, CRP, covid-19, RSV and influenza A+B PCR, EBV Ab, Fibrinogen, Factor V liden, Prothrombin 20210 G/A mutation Neurology Consult Hematology Consult Admitted to ICU
CDC Split Type:
Write-up: 17-year-old male who presents with 8 days of headache. He received his first dose of the Pfizer vaccine on 4/21. He felt like he had the flu after getting the vaccine and developed right-sided neck pain and a temperature to 100. The patient did endorse being elbowed in the neck playing basketball during this time as well, as he played in a basketball tournament in right after this. He got his Covid vaccine in his right deltoid. He saw his pediatrician on 4/26 and a CT scan of his neck with IV contrast was done and this showed significant diffuse right-sided deep spatial neck edema and right-sided adenopathy. The pediatrician discussed the findings with ENT who recommended augmentin and a medrol dosepak. The patient developed a headache several days after this and went to urgent care for evaluation. There was concern that the augmentin and steroids had caused the headache, so the steroids were stopped and he was switched to keflex on 4/30. He was given phenergan and toradol at Urgent Care and discharged home. His mom notes that several days ago he had fevers of 101-104. He has not had a fever for several days now. His headache continued and he felt unwell at basketball practice so he returned to urgent care on 5/4. A CT scan of his head was done which showed right sigmoid and transverse sinus thrombosis as well as thrombophlebitis of the right IJ. He was sent to ED for further management at that time. In the ED, the patient was hemodynamically stable and well-appearing. The CTs were overread by our radiologists here. The patient had some labs done at the outside urgent care but PT/PTT/INR and a CRP were drawn here, which were unremarkable. A Covid PCR is negative. Neurosurgery, neurology, and hematology were consulted. Neurology recommended heparin and a hypercoagulable workup and hematology agreed with this plan. The patient was admitted to the ICU for neuro checks and monitoring during initiation of heparin. |
|
| VAERS ID: |
1310737 (history) |
| Form: |
Version 2.0 |
| Age: |
18.0 |
| Sex: |
Female |
| Location: |
Ohio |
| Vaccinated: | 2021-04-07 |
| Onset: | 2021-05-03 |
| Days after vaccination: | 26 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-05-12 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN |
201A21A / UNK |
- / - |
Administered by: Private Purchased by: ?
Symptoms: Deep vein thrombosis,
Pain in extremity,
Peripheral swelling,
Thrombophlebitis superficial
SMQs:, Cardiac failure (broad), Angioedema (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: ? polyethylene glycol 3350 17 gram/dose oral powder (Miralax) ? famotidine 40 mg tablet (Pepcid) ? lansoprazole 30 mg capsule,delayed release (Prevacid) ? linaCLOtide 145 mcg capsule (Linzess) ? azelastine 137 mcg (0.1 %) nasal spra
Current Illness: G tube site cellulitis
Preexisting Conditions: AV canal s/p repair, gastric fisula at G tube site s/p repair, obesity, asthma, nocturnal enuresis, IBS, premature baby- had multiple central lines placed as an infant
Allergies: environmental
Diagnostic Lab Data: US doppler on 5/3/21
CDC Split Type:
Write-up: Deep venous thrombosis involving the common femoral vein and central portions of both superficial and deep femoral veins. Thrombus is also present within the saphenous vein. symptoms- leg swelling and pain since 5/2/21 |
|
| VAERS ID: |
1320793 (history) |
| Form: |
Version 2.0 |
| Age: |
17.0 |
| Sex: |
Male |
| Location: |
Utah |
| Vaccinated: | 2021-04-16 |
| Onset: | 2021-04-27 |
| Days after vaccination: | 11 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-05-15 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
LA / SYR |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 2 |
LA / SYR |
Administered by: Public Purchased by: ?
Symptoms: Appendicitis,
Laboratory test,
Pulmonary thrombosis,
Thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Bupropion, sertraline, clonidine
Current Illness: Depression
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Dozens and dozens of labs/tests were run after admitted to hospital for both cases. (We?re still currently in the hospital for appendix)
CDC Split Type:
Write-up: After 1st shot; Patient developed multiple blood clots (lungs and legs) about 10-11 days afterwards. All tests for cause of clots were inconclusive. Patient received his second dose and with in 48 hours was hospitalized for appendicitis. If it was a reaction after just one shot, I would normally think it was a coincidence. With him have severe reactions after both shots, it seems very suspicious! |
|
| VAERS ID: |
1323977 (history) |
| Form: |
Version 2.0 |
| Age: |
16.0 |
| Sex: |
Female |
| Location: |
Ohio |
| Vaccinated: | 2021-05-17 |
| Onset: | 2021-05-17 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-05-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EW0158 / 2 |
UN / IM |
Administered by: Private Purchased by: ?
Symptoms: Anticoagulant therapy,
Chest pain,
Computerised tomogram thorax abnormal,
Deep vein thrombosis,
Intensive care,
Pulmonary embolism,
Ultrasound Doppler abnormal
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: norgestimate-ethinyl estradiol, ferrous sulfate
Current Illness: none
Preexisting Conditions: iron deficiency anemia, prolonged uterine bleeding
Allergies: none known
Diagnostic Lab Data: ultrasound of R leg with DVT Chest CT with bilateral pulmonary emboli
CDC Split Type:
Write-up: Presented with acute onset chest pain, found to have right lower extremity DVT and bilateral PEs. Required short stay in ICU for close monitoring given clot burden in her lungs. Required heparin infusion and then transitioned to lovenox for home-going therapy. |
|
| VAERS ID: |
1337043 (history) |
| Form: |
Version 2.0 |
| Age: |
18.0 |
| Sex: |
Male |
| Location: |
Unknown |
| Vaccinated: | 2021-05-08 |
| Onset: | 2021-05-12 |
| Days after vaccination: | 4 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-05-21 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
- / UNK |
- / - |
Administered by: Public Purchased by: ?
Symptoms: Cerebral thrombosis,
Intensive care,
Magnetic resonance imaging head abnormal,
Seizure
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Ischaemic central nervous system vascular conditions (narrow), Convulsions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (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? No
Hospitalized? Yes, 3 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Patient received dose 1 of Moderna vaccine on 5/8/2021 and had witnessed seizure 5/12/2021- (first time ever). He was admitted to ICU on 5/12/2021 and discharged 5/15/2021. He states he had one seizure while in the ICU and another seizure 5/16/2021- at home after discharge. He has since been placed on anti-seizure medications and is scheduled for follow up with neurology on 6/2/2021. Patient''s mother states ICU doctors told her they found a blood clot in the brain picked up by MRI. |
|
| VAERS ID: |
1347325 (history) |
| Form: |
Version 2.0 |
| Age: |
17.0 |
| Sex: |
Male |
| Location: |
D.C. |
| Vaccinated: | 2021-05-07 |
| Onset: | 2021-05-23 |
| Days after vaccination: | 16 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-05-25 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 2 |
UN / IM |
Administered by: Private Purchased by: ?
Symptoms: Activated partial thromboplastin time abnormal,
Anticoagulant therapy,
Back pain,
Catheter directed thrombolysis,
Coagulation test abnormal,
Deep vein thrombosis,
Groin pain,
Pain in extremity,
Peripheral swelling,
Protein S decreased,
Renal vein thrombosis,
Vena cava thrombosis
SMQs:, Cardiac failure (broad), Liver-related coagulation and bleeding disturbances (narrow), Angioedema (broad), Haemorrhage laboratory terms (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Osteonecrosis (broad), Renovascular disorders (narrow), Tendinopathies and ligament 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? Yes, 2 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Protein S is low. aPTT abnormal with abnormal mixing study suggesting possible lupus anticoagulant. Further tests pending.
CDC Split Type:
Write-up: Patient presented with one week of back, right leg and right groin pain. Right lower extremity swelling and was diagnosed with deep vein thrombosis from right popliteal vein into IVC involving a renal vein. He is on anticoagulation currently and going for catheter-directed thrombolysis today. Patient has been in hospital two days and hospitalization is ongoing at the time of this report. |
|
| VAERS ID: |
1357945 (history) |
| Form: |
Version 2.0 |
| Age: |
19.0 |
| Sex: |
Female |
| Location: |
Texas |
| Vaccinated: | 2021-04-18 |
| Onset: | 2021-05-05 |
| Days after vaccination: | 17 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-05-28 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
046821A / 2 |
UN / IM |
Administered by: Pharmacy Purchased by: ?
Symptoms: Back pain,
Cardio-respiratory arrest,
Deep vein thrombosis,
Dyspnoea,
Lung assist device therapy,
Movement disorder,
Pain in extremity,
Pulmonary embolism
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, venous (narrow), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Noninfectious myocarditis/pericarditis (broad)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 14 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lo loestrin Fe oral
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:
Write-up: extensive deep vein thrombosis with embolization and massive pulmonary embolism ; patient presented with shortness of breath and severe bilateral leg and back pain unable to move with extensive thrombosis noted. patient had cardiopulmonary arrest was on ecmo now decannulated and extubated , awake, alert oriented in recovery phase |
|
| VAERS ID: |
1358106 (history) |
| Form: |
Version 2.0 |
| Age: |
17.0 |
| Sex: |
Female |
| Location: |
Massachusetts |
| Vaccinated: | 2021-05-18 |
| Onset: | 2021-05-22 |
| Days after vaccination: | 4 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-05-28 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EW0185 / 1 |
LA / IM |
Administered by: Pharmacy Purchased by: ?
Symptoms: Paget-Schroetter syndrome,
Peripheral swelling,
Skin discolouration,
Subclavian vein occlusion,
Subclavian vein thrombosis,
Thrombolysis,
Ultrasound Doppler abnormal,
Venogram abnormal
SMQs:, Cardiac failure (broad), Angioedema (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: strattera, lexapro
Current Illness: none
Preexisting Conditions: She has a known prothrombin gene mutation (G20210A) that was previously identified because of a family history of thrombosis.
Allergies: azithromycin, prednisone
Diagnostic Lab Data: see above.
CDC Split Type:
Write-up: Vaccine 5/18. On 5/22 4 days after vaccine, she developed right arm swelling and skin discoloration. On 5/23 she went to the ED. Ultrasound revealed acute, occlusive thrombosis of right subclavian vein. She was admitted to the hospital, started on enoxaparin, achieved therapeutic levels. On 5/25 she underwent thrombolysis and venogram and was confirmed to have findings consistent with Paget-Schroetter syndrome. She was discharged home on 5/25 in good condition. Note: she also has known prothrombin gene mutation G20210A that confers an increased risk of thrombosis. She does have repetitive use of the right arm (lacrosse player). |
|
| VAERS ID: |
1365073 (history) |
| Form: |
Version 2.0 |
| Age: |
19.0 |
| Sex: |
Female |
| Location: |
Massachusetts |
| Vaccinated: | 2021-05-20 |
| Onset: | 2021-05-28 |
| Days after vaccination: | 8 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-06-01 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
- / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Deep vein thrombosis,
Ultrasound Doppler
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: heterozygosity for factor V Leiden
Allergies:
Diagnostic Lab Data: doppler ultrasound LUE on 5/28
CDC Split Type:
Write-up: deep venous thrombosis of left axillary vein in same arm as vaccine was administered |
|
| VAERS ID: |
1365379 (history) |
| Form: |
Version 2.0 |
| Age: |
19.0 |
| Sex: |
Female |
| Location: |
Hawaii |
| Vaccinated: | 2021-01-26 |
| Onset: | 2021-01-29 |
| Days after vaccination: | 3 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-06-01 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
- / - |
Administered by: Military Purchased by: ?
Symptoms: Abdominal pain,
Anticoagulant therapy,
Back pain,
Deep vein thrombosis,
Laboratory test,
Pain in extremity,
Peripheral swelling,
Pulmonary embolism,
Thrombectomy
SMQs:, Cardiac failure (broad), Acute pancreatitis (broad), Angioedema (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Birth Control
Current Illness: none
Preexisting Conditions: none
Allergies: no
Diagnostic Lab Data: more than 30+
CDC Split Type:
Write-up: 1st day of pain: Extreme Pain in Lower Extremities (Right Leg, Right abdomen, right lower back) Swelling of Right Leg 3rd day: Admitted into the hospital after visiting the ER Acute DVT in R Leg, multiple Pulmonary Embolisms 3rd-5th day in hospital: 2 Surgical Procedures to remove blood clot, on Blood thinners for a year to life |
|
| VAERS ID: |
1367764 (history) |
| Form: |
Version 2.0 |
| Age: |
12.0 |
| Sex: |
Male |
| Location: |
West Virginia |
| Vaccinated: | 2021-05-21 |
| Onset: | 2021-05-25 |
| Days after vaccination: | 4 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-06-02 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EW0171 / 1 |
LA / SYR |
Administered by: School Purchased by: ?
Symptoms: Induration,
Nodule,
Tenderness,
Thrombosis,
Ultrasound scan
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Extravasation events (injections, infusions and implants) (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ??Prozac, Amphetamine Salts er,Abilify,Trileptal
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: Ultrasound of left arm?
CDC Split Type:
Write-up: He got a superficial blood clot in left arm ?He''s got the shot May 21 and I noticed he had two hard knots on left arm and there was probably about a half inch between them and as hard as a rock on that following Monday may 24,2021 , he said it was sore some more when you touched it we was told to keep an ion it make sure it didn''t get any worse, turn red, swell, feel hot to the touch, and then to put a warm compresses on it ?? |
|
| VAERS ID: |
1376919 (history) |
| Form: |
Version 2.0 |
| Age: |
17.0 |
| Sex: |
Male |
| Location: |
Arizona |
| Vaccinated: | 2021-04-24 |
| Onset: | 2021-05-08 |
| Days after vaccination: | 14 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-06-07 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EW0150 / 1 |
LA / SYR |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
ER8729 / 2 |
LA / SYR |
Administered by: Pharmacy Purchased by: ?
Symptoms: Anticoagulant therapy,
Computerised tomogram,
Deep vein thrombosis,
Hypoaesthesia,
Laboratory test,
Nasopharyngitis,
Paraesthesia,
Peripheral artery thrombosis,
Surgery,
Ultrasound scan
SMQs:, Peripheral neuropathy (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Guillain-Barre syndrome (broad), Sexual dysfunction (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 8 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vitamin D Primidone for tremors
Current Illness: None
Preexisting Conditions: Tremors and allergies
Allergies: Allergy to melon, olives, orange blossom, and some environmental allergies
Diagnostic Lab Data: Multiple tests run including CT and ultra sounds from 5/25/21 through 5/29/21. Hospital has records.
CDC Split Type:
Write-up: First shot received on 4/3/21, and second received on 4/24/21. Symptoms of cold, tingling, and numb left toes and left foot noticed about 2 weeks after 2nd Pfizer dose. Went to ER and blood clots were found in arteries in left knee and ankle, and clots in the vein in left calf. Four procedures performed by Intervention Radiology (IR) at Hospital on 5/25/21, and was treated with Heparin and TPA. Released from hospital with clot remaining in left calf vein and is taking Eliquis. Continuing treatment with hematologist post release from hospital. |
|
| VAERS ID: |
1377017 (history) |
| Form: |
Version 2.0 |
| Age: |
18.0 |
| Sex: |
Female |
| Location: |
New York |
| Vaccinated: | 2021-04-20 |
| Onset: | 2021-05-16 |
| Days after vaccination: | 26 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-06-07 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
- / UNK |
UN / - |
Administered by: Private Purchased by: ?
Symptoms: Acute respiratory distress syndrome,
Confirmed e-cigarette or vaping product use associated lung injury,
Deep vein thrombosis,
Dyspnoea,
Endotracheal intubation,
Gastrointestinal disorder,
Pyrexia,
Systemic inflammatory response syndrome
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (narrow), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (broad), Opportunistic infections (broad), Immune-mediated/autoimmune 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? Yes, ? days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lexapro, Atarax
Current Illness:
Preexisting Conditions: Concern for substance use, depression
Allergies: None
Diagnostic Lab Data:
CDC Split Type:
Write-up: The patient developed progressively worsening dyspnea, GI symptoms and fevers starting 5/16/2021, 3.5 weeks after receiving second Moderna vaccine. She was admitted 5/22/2021 with ARDS requiring intubation, found to have severe systemic inflammation with acute DVT of right right subclavian, axillary, brachial, and upper arm radial veins, chronic DVT of left subclavian, and possible thrombus tricuspid valve. Remains intubated with ongoing evidence of systemic inflammation. Working diagnosis EVALI. |
|
| VAERS ID: |
1381062 (history) |
| Form: |
Version 2.0 |
| Age: |
19.0 |
| Sex: |
Female |
| Location: |
Pennsylvania |
| Vaccinated: | 2021-05-14 |
| Onset: | 2021-05-01 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-06-08 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EW0182 / 1 |
LA / - |
Administered by: Pharmacy Purchased by: ?
Symptoms: Contusion,
Fatigue,
Malaise,
Nausea,
Pain,
Pyrexia,
Thrombosis
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Accidents and injuries (narrow), 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? 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 INC2021581727
Write-up: blood clots; she did get really sick / she was displaying a lot of symptoms; fever; whole body was aching; fatigue; nauseated; bruises on the legs / now she''s getting more / she would say they have worsened; This is a spontaneous report received from a contactable consumer (patient''s mother). A 19-year-old female patient received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, lot number: EW0182), via an unspecified route of administration in arm left on 14May2021 at single dose for COVID-19 immunisation. The patient medical history and concomitant medications were not reported. Patient previously received flu shot and experienced nausea. The patient experienced blood clots on an unspecified date, bruises on the legs, she was getting more, she would say they have worsened in May2021, fever on 15May2021, whole body was aching on 15May2021, fatigue on 15May2021, nauseated on 15May2021, and she did get really sick, she was displaying a lot of symptoms on an unspecified date. Patient started having bruises on the legs and thought that it might be related to blood clots. She mentioned that she also experienced the common side effects but she was not concerned of that as people she knew also had those symptoms but was more concerned about the bruising. On patient''s legs, she had a bunch of bruises. Reporter was just really nervous about her daughter''s bruises. When patient was working, she was not noticing, but today patient noticed her legs and said reporter it was a lot of them. Patient did get really sick with her first shot, she had a fever, she couldn''t go to work the next day. Reporter was not sure if the patient should get the second dose on 04Jun2021. Patient''s whole body was aching, she was nauseated, she was displaying a lot of symptoms. Reporter checked online and they said it was a normal thing. Patient came down and showed reporter the bruises. Patient wasn''t really paying attention to them. Patient had one or two bruises when she noticed and at the time of the report she was getting more. They had worsened. Patient took ibuprofen (ADVIL) for fever and she felt better. Outcome of events blood clots and she did get really sick, she was displaying a lot of symptoms was unknown, of event bruises on the legs, she was getting more, she would say they have worsened was not resolved, and of other events was resolved. |
|
| VAERS ID: |
1382163 (history) |
| Form: |
Version 2.0 |
| Age: |
19.0 |
| Sex: |
Female |
| Location: |
Tennessee |
| Vaccinated: | 2021-05-01 |
| Onset: | 2021-05-26 |
| Days after vaccination: | 25 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-06-08 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EW153 / 1 |
- / IM |
Administered by: Private Purchased by: ?
Symptoms: Angiogram cerebral abnormal,
Cerebral venous sinus thrombosis,
Computerised tomogram head abnormal,
Headache,
Migraine,
Nausea,
Subdural haematoma,
Syncope,
Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Accidents and injuries (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Central nervous system vascular disorders, not specified as haemorrhagic or ischaemic (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (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? Yes, 8 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: diclofenac sodium 50 mg oral delayed release tablet birth control (unknown specifics) prochlorperazine 10 mg oral tablet
Current Illness:
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data: see above
CDC Split Type:
Write-up: 2nd COVID19 Pfizer vaccine 5/1/21 lot # EW0167. both vaccines received at pharmacy. 5/24/21 awoke at 0400 with headache and nausea and vomiting. Headache worsened throughout the day and went to ED where she had syncopal episode and was treated for migraine headache with migraine cocktail and sent home. Symptoms continued and progressed the next day and she went to Hospital ED in where a CTH revealed SDH near her sinuses. She was transferred to Medical Center in for higher level of care. On arrival she had a CTH/CTA which revealed and extensive central venous sinus thrombosis. |
|
| VAERS ID: |
1384595 (history) |
| Form: |
Version 2.0 |
| Age: |
17.0 |
| Sex: |
Female |
| Location: |
Florida |
| Vaccinated: | 2021-05-03 |
| Onset: | 0000-00-00 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-06-09 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
RA / - |
| UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
Administered by: Pharmacy Purchased by: ?
Symptoms: Dizziness,
Fatigue,
Muscle spasms,
Thrombosis
SMQs:, Anticholinergic syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Dystonia (broad), Thrombophlebitis (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: USPFIZER INC2021593296
Write-up: received the first dose of the Pfizer COVID-19 vaccine and also recently started taking Depo-Provera. After receiving the first dose of the Pfizer COVID-19 vaccine her daughter developed a blood clot; tired and frail; feels lost and light headed; cramping pain; This is a spontaneous report from a contactable consumer (Patient''s mother). A 17-year-old female patient received first dose of BNT162B2 (BNT162B2) via an unspecified route of administration, administered in Arm Right on 03May2021 15:00 (Batch/Lot number was not reported) as 1ST DOSE SINGLE for covid-19 immunization and medroxyprogesterone acetate (DEPO-PROVERA), route of administration, start and stop date, batch/lot number and dose were not reported for contraception. The patient''s medical history and concomitant medications were not reported. The patient experienced received the first dose of the pfizer covid-19 vaccine and also recently started taking depo-provera. after receiving the first dose of the pfizer covid-19 vaccine her daughter developed a blood clot, tired and frail, feels lost and light headed and had cramping pain all on unspecified dates. It was reported that after receiving the first dose of the Pfizer COVID-19 vaccine her daughter developed a blood clot. Her daughter, who is currently on Depo Provera got her first dose of the Covid 19 vaccine. The daughter has been experiencing blood clotting and would like to further document this experience. Is also seeking medical advice to inform her daughter. Her daughter Has been on Depo Provera for 4 to 5 months. Since she had the Covid vaccine, she has been having bad blood clotting and has been having a continuous period. When she got the shot, she has been getting blood clots straight for three weeks. Patient is Tired and frail: She is a waitress, so all of this has made it hard. It started right when she got the shot and has pretty much stayed the same. She will feel like she is lost when she wakes up and is light headed from the loss of blood. It occurs when she is doing activities, like working. Patient took some Midol one day for cramping pain but it barely did anything. The action taken for medroxyprogesterone acetate was unknown. Outcome of tired and frail was not recovered. Outcome of all the other events was unknown. Information on Lot/Batch number was not available. Additional information has been requested. |
|
| VAERS ID: |
1385500 (history) |
| Form: |
Version 2.0 |
| Age: |
15.0 |
| Sex: |
Female |
| Location: |
Pennsylvania |
| Vaccinated: | 2021-06-04 |
| Onset: | 2021-06-06 |
| Days after vaccination: | 2 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-06-09 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 2 |
LA / IM |
Administered by: Public Purchased by: ?
Symptoms: Heavy menstrual bleeding,
Menstruation irregular,
Thrombosis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Fertility 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: Fluoxetine, 20 mg daily
Current Illness: No
Preexisting Conditions: Born with one kidney
Allergies: Spring time pollen allergies
Diagnostic Lab Data: None. We have communicated with our pediatrician, who encouraged us to report the occurence.
CDC Split Type:
Write-up: Very heavy period began, 2 weeks ahead of schedule. Much heavier bleeding began after about 12 hours and has continued for 3 days. This level of bleeding is not typical. Many blood clots have also been passed. |
|
| VAERS ID: |
1386054 (history) |
| Form: |
Version 2.0 |
| Age: |
18.0 |
| Sex: |
Female |
| Location: |
Ohio |
| Vaccinated: | 2021-05-14 |
| Onset: | 2021-06-06 |
| Days after vaccination: | 23 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-06-09 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
- / 2 |
RA / - |
Administered by: Public Purchased by: ?
Symptoms: Autopsy,
Death,
Thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-06-06
Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: VANAFLAXINE BUSPIRONE ABILIFY SPRINTEC
Current Illness: CHLAMYDIA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data: AUTOPSY 6/8/21
CDC Split Type:
Write-up: DEATH FROM BLOOD CLOT |
|
| VAERS ID: |
1392656 (history) |
| Form: |
Version 2.0 |
| Age: |
17.0 |
| Sex: |
Female |
| Location: |
Ohio |
| Vaccinated: | 2021-06-07 |
| Onset: | 2021-06-08 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-06-11 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EW0153 / 2 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Anticoagulant therapy,
Deep vein thrombosis,
Iliac vein occlusion,
Pelvic venous thrombosis,
Peripheral vein occlusion,
Thrombolysis,
Vascular operation,
Venogram abnormal
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (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, 5 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Xulane 150-35 mcg/ 24 hour patch ( birth control), Lexapro, Midodrine, Mag-Ox, Corlanor
Current Illness: None
Preexisting Conditions: repaired gastroschisis, left thoracic outlet syndrome surgery, POTS (postural orthostatic tachycardia syndrome), and tension headaches
Allergies: Morphine
Diagnostic Lab Data: MRV pelvis on 6/9: Complete occluding thrombosis beginning in the right groin of the right venous system, the common femoral vein is occluded as are the right internal and external iliac veins and numerous smaller unnamed pelvic veins. Thrombus extends into and occludes the right common iliac although a left to the level of the expected anastomosis with the left system to form the IVC. There is no evidence of thrombus in the IVC. On the left side, clot is seen occluding several left-sided unnamed pelvic veins, thrombosis extends into the left internal iliac vein which is occluded, thrombus extends into the left common iliac which contains nonoccluding thrombus leading up to just proximal to the formation of the IVC. The left external iliac and the common femoral vein on the left side are patent.
CDC Split Type:
Write-up: Patient with significant right leg DVT requiring thrombolysis by vascular surgery. She will need to continue on anticoaggulants outpatient. |
|
| VAERS ID: |
1392757 (history) |
| Form: |
Version 2.0 |
| Age: |
16.0 |
| Sex: |
Female |
| Location: |
Unknown |
| Vaccinated: | 2021-05-28 |
| Onset: | 2021-06-01 |
| Days after vaccination: | 4 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-06-11 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / UNK |
- / - |
Administered by: Private Purchased by: ?
Symptoms: Anticoagulant therapy,
Chest pain,
Coagulation test normal,
Deep vein thrombosis,
Electrocardiogram abnormal,
Fibrin D dimer increased,
Haemoptysis,
Imaging procedure abnormal,
Pain in extremity,
Peripheral swelling,
Pleuritic pain,
Pulmonary embolism,
SARS-CoV-2 antibody test,
Sinus tachycardia
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Dehydration (broad), COVID-19 (broad), Noninfectious myocarditis/pericarditis (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? Yes, ? days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Was taking tylenol q4 for 3-4 days prior to today for pain Also took 1-2 doses of naproxen at home OCP use for a month prior to today
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: D Dimer 4000 Normal coags COVID IGG 184 AU/ml EKG sinus tachy
CDC Split Type:
Write-up: Patient vaccinated on 5/28. She reported having pleuritic chest pain and hemoptysis 3 days after that lasted about a week. Then after she developed right leg pain and swelling x 3 days. Seen at our ER 6/11- studies show DVT of the common femoral vein and other veins of the right lower extremity. Also had b/l pulmonary emboli. Started on lovenox treatment and pending thrombectomy by vascular surgeons in 2 days. (In addition she also had admitted to OCP use for a month prior to this event; no reported FH of clotting disorders) |
|
| VAERS ID: |
1408002 (history) |
| Form: |
Version 2.0 |
| Age: |
16.0 |
| Sex: |
Male |
| Location: |
Utah |
| Vaccinated: | 2021-05-24 |
| Onset: | 2021-06-02 |
| Days after vaccination: | 9 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-06-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EW0178 / 2 |
LA / SYR |
Administered by: Pharmacy Purchased by: ?
Symptoms: Anticoagulant therapy,
Deep vein thrombosis,
Pain in extremity,
Ultrasound Doppler abnormal
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Daily multi-vitamin
Current Illness: None
Preexisting Conditions: None
Allergies: No known
Diagnostic Lab Data: 06/07/2021: Ultrasound performed in the ER. Diagnosis was Deep Vein Thrombosis (DVT) of distal vein of right lower extremity.
CDC Split Type:
Write-up: Pain in the back of patient''s right calf started after a flight on 6/2/2021. We ended up in the ER on 6/7/2021. There he was diagnosed per ultrasound with DVT or having a blood clot in a vein in his right calf. He was prescribed Eliquis and counseled to follow up with his physician at home. Patient met with our family physician on 6/9/2021, the day we arrived home to follow-up. After receiving the medical records Dr. advised us to file this report. We understand that blood clots can happen on flights, but Dr. felt that this event was such an anomally for patient that it merited further reporting. Patient is a completely healthy 16 year old male who is an extremely active athlete who participates in basketball, track, cross-country and other physical activities daily. For him to develop a blood clot after a 4 hour flight is an exceptional, unexpected event. Dr. long term plan is to keep patient on Eliquis for 6 months, then take him off of the medicine and then run more blood tests after 2 weeks to fully investigate the incident. |
|
| VAERS ID: |
1408197 (history) |
| Form: |
Version 2.0 |
| Age: |
18.0 |
| Sex: |
Female |
| Location: |
Virginia |
| Vaccinated: | 2021-04-21 |
| Onset: | 2021-04-21 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-06-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 2 |
RA / IM |
Administered by: Other Purchased by: ?
Symptoms: Gait disturbance,
Pain in extremity,
Thrombosis,
Ultrasound scan
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Parkinson-like events (broad), Thrombophlebitis (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Xulane (Birth Control Patch)
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: No
Diagnostic Lab Data: Ultrasound on my knee done on 4/24 - Found DVT in my left knee ; Xarelto started Office Visit 5/5 - Hematologist told me not to go back on any birth control with Estrogen in it; He also ordered a lot of tests to test for clotting disorders; my blood was taken this day Virtual Visit 5/12 - Me and my doctor went over my labs; he told me that my labs showed that I do not have a clotting disorder; Dr. also that he wanted me to stay on the Xarelto for 6 months because he doesn''t know where the blood clot came from
CDC Split Type:
Write-up: I started experiencing pain in my calf on 4/21 that same night of the vaccination. There was a tight feeling in my knee and every time I took a step with my right leg there was pain that radiated down my calf. It almost felt like a muscle pain so I ignored it for a few days. By 4/24 the pain had gotten so bad that I didn''t want to walk anywhere and cried when I walked. My mom came and picked me up and took me to the urgent care center. They asked me a few questions and told me that I needed to go to the ER to get checked for a blood clot. I went to hospital on 4/24, and an ultrasound of my knee was done. The doctor diagnosed me with a blood clot and told me to stop taking the Xulane which was my birth control at the time. They told me to follow up with my OBGYN and a hematologist. (I had been on my birth control for about 6 months and I have never had any issues with blood clots and they do not run in my family. The NP is who told me to report my blood clot to the CDC because she is a little suspicious that the shot is where it come from.) |
|
| VAERS ID: |
1413393 (history) |
| Form: |
Version 2.0 |
| Age: |
14.0 |
| Sex: |
Female |
| Location: |
Ohio |
| Vaccinated: | 2021-05-21 |
| Onset: | 2021-05-22 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-06-20 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EW0168 / 1 |
LA / IM |
Administered by: Pharmacy Purchased by: ?
Symptoms: Thrombosis,
Vaginal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (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: Patient started birth control on 05/22/2021, no other medications reported
Current Illness: None reported
Preexisting Conditions: None reported
Allergies: Neosporin and Bactroban
Diagnostic Lab Data: None reported - her physician wanted to wait and see
CDC Split Type:
Write-up: The next day after vaccination the patient started having vaginal bleeding that lasted for 30 days. She was even bleeding out clots of blood |
|
| VAERS ID: |
1427461 (history) |
| Form: |
Version 2.0 |
| Age: |
14.0 |
| Sex: |
Female |
| Location: |
Ohio |
| Vaccinated: | 2021-05-22 |
| Onset: | 2021-06-20 |
| Days after vaccination: | 29 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-06-25 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / UNK |
- / - |
Administered by: Unknown Purchased by: ?
Symptoms: Cerebral venous thrombosis
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (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? Yes, ? days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Oral contraceptive
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Intracranial venous thrombosis |
|
| VAERS ID: |
1429410 (history) |
| Form: |
Version 2.0 |
| Age: |
18.0 |
| Sex: |
Female |
| Location: |
Georgia |
| Vaccinated: | 2021-04-18 |
| Onset: | 2021-04-23 |
| Days after vaccination: | 5 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-06-26 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EW0158 / 2 |
RA / - |
Administered by: Unknown Purchased by: ?
Symptoms: Acute kidney injury,
Nephrotic syndrome,
Peripheral swelling,
Thrombosis,
Urinary retention,
Weight increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Proteinuria (broad), 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: LEVOCETIRIZINE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021691761
Write-up: A doctors office visit on 4/28. Discussed the symptoms (minimal change disease-like symptoms, possible nephrotic syndrome, possible acute kidney injury, possible blood clots).; A doctors office visit on 4/28. Discussed the symptoms (minimal change disease-like symptoms, possible nephrotic syndrome, possible acute kidney injury, possible blood clots).; A doctor''s office visit on 4/28. Discussed the symptoms (minimal change disease-like symptoms, possible nephrotic syndrome, possible acute kidney injury, possible blood clots).; no facilitated urination; Severe swelling on both legs with sudden body weight increase (over 10 lbs) after about a week of second dose; Severe swelling on both legs with sudden body weight increase (over 10 lbs) after about a week of second dose; This is a spontaneous report form a contactable consumer (patient) reported for herself. A 18-year-old non pregnant female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE Solution for injection Batch/Lot Number: EW0158) via an unspecified route of administration in arm right on 18Apr2021 as dose 2, single for covid-19 immunisation. Medical history included none history. Concomitant medications include levocetirizine (LEVOCETIRIZINE Batch/Lot number was not reported) via an unspecified route of administration from an unspecified date, at 5 mg for an unspecified indication. Historical vaccine includes bnt162b2 (Dose 1 lot number=EP7534 vaccine location=Right arm) on 26Mar2021 for COVID-19 immunization. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. Prior to vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient has not been tested for COVID-19. On 23Apr2021, the patient experienced a doctors office visit on 28Apr. Discussed the symptoms (minimal change disease-like symptoms, possible nephrotic syndrome, possible acute kidney injury, possible blood clots). Started to take 20mg furosemide for 7 days from 28Apr and 20mg prednisone for 10 days and 20mg furosemide on 04May. Even after finishing medication, there were no changes in symptoms. Continued leg swelling and no facilitated urination. There was severe swelling on both legs with sudden body weight increase (over 10 lbs) after about a week of second dose. After finishing both, the swelling in legs subsided and weight returned to normal. About 10 days later, moderate swelling in legs returned and body weight increased by about 5 lbs. The patient visited nephrologist visit on 02Jun and was prescribed 20mg prednisone, 3 tablets every other am for 20 days. Currently, patient have been taking the medicine since 03Jun. As of now 12Jun2021, the leg swelling partially decreased and the body weight decreased by 1-1.5 lbs. The clinical outcome of all the events was not resolved. |
|
| VAERS ID: |
1430179 (history) |
| Form: |
Version 2.0 |
| Age: |
16.0 |
| Sex: |
Female |
| Location: |
Texas |
| Vaccinated: | 2021-05-30 |
| Onset: | 2021-06-12 |
| Days after vaccination: | 13 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-06-27 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EW0187 / 2 |
UN / UN |
Administered by: Private Purchased by: ?
Symptoms: Anticoagulant therapy,
Cerebral thrombosis
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: contraceptive
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: Blood clots on the brain Tuesday June 15th 2021
CDC Split Type:
Write-up: Blood clots on brain. Needed to be hospitalized for 5 days on blood thinners. Will Continues to self administer blood thinners for 3 more months |
|
| VAERS ID: |
1430330 (history) |
| Form: |
Version 2.0 |
| Age: |
16.0 |
| Sex: |
Male |
| Location: |
Oregon |
| Vaccinated: | 2021-05-25 |
| Onset: | 2021-06-23 |
| Days after vaccination: | 29 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-06-27 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / UNK |
- / - |
Administered by: Pharmacy Purchased by: ?
Symptoms: Basilar artery thrombosis,
Computerised tomogram,
Magnetic resonance imaging,
SARS-CoV-2 antibody test positive,
Status epilepticus
SMQs:, Systemic lupus erythematosus (broad), Ischaemic central nervous system vascular conditions (narrow), Convulsions (narrow), Embolic and thrombotic events, arterial (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (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? Yes, 4 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: sertraline 100mg daily, sumatriptan prn migraine
Current Illness: NA
Preexisting Conditions: depression
Allergies: PCN
Diagnostic Lab Data: 6/23 current admission multiple MRIs and CTs 6/25 SARS IgG +
CDC Split Type:
Write-up: admitted 6/23 in status epilepticus. Found to have a basilar artery thrombus |
|
| VAERS ID: |
1430451 (history) |
| Form: |
Version 2.0 |
| Age: |
19.0 |
| Sex: |
Female |
| Location: |
Washington |
| Vaccinated: | 2021-05-11 |
| Onset: | 2021-06-15 |
| Days after vaccination: | 35 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-06-27 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
- / 1 |
AR / SYR |
Administered by: Pharmacy Purchased by: ?
Symptoms: Heavy menstrual bleeding,
Muscle spasms,
Thrombosis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Dystonia (broad), Thrombophlebitis (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: Allergy medication Iron supplement
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:
Write-up: Extremely heavy period, blood clotting, and intense cramps throughout the month |
|
| VAERS ID: |
1430529 (history) |
| Form: |
Version 2.0 |
| Age: |
18.0 |
| Sex: |
Male |
| Location: |
Virginia |
| Vaccinated: | 2021-05-18 |
| Onset: | 2021-06-03 |
| Days after vaccination: | 16 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-06-28 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
BR6716 / 1 |
RA / IM |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EW0186 / 2 |
RA / IM |
Administered by: Pharmacy Purchased by: ?
Symptoms: Deep vein thrombosis,
Pain,
Peripheral swelling,
Thrombosis,
Ultrasound scan abnormal
SMQs:, Cardiac failure (broad), Angioedema (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: tree nuts, cefazolin
Diagnostic Lab Data: Ultrasound done in ED and patient diagnosed with DVT.
CDC Split Type:
Write-up: Blood Clot/DVT Pain and swelling in lower extremity following left elbow reconstruction with contralateral gracilis autograft. |
|
| VAERS ID: |
1431554 (history) |
| Form: |
Version 2.0 |
| Age: |
19.0 |
| Sex: |
Female |
| Location: |
Michigan |
| Vaccinated: | 2021-01-23 |
| Onset: | 2021-02-04 |
| Days after vaccination: | 12 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-06-28 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL0140 / 1 |
LA / SYR |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL3248 / 2 |
LA / SYR |
Administered by: Private Purchased by: ?
Symptoms: Anticoagulant therapy,
Antiphospholipid syndrome,
Cardiac dysfunction,
Chest pain,
Dyspnoea,
Pulmonary thrombosis,
Stress cardiomyopathy,
Thrombectomy
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (narrow), Other ischaemic heart disease (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (broad), Immune-mediated/autoimmune disorders (narrow)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lexapro Birth control (Viorelle)
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Patient experienced shortness of breath and chest pain resulting in a visit to the ER (02/07/2021) where doctors found multiple blood clots in lungs as well as decreased heart function due to stress on cardiac system. Patient was hospitalized for 3 days and had to have an INR procedure to remove the blood clots (Patient is now on blood thinner and diagnosed with Antiphospholipid Syndrome after event.) |
|
| VAERS ID: |
1440900 (history) |
| Form: |
Version 2.0 |
| Age: |
16.0 |
| Sex: |
Female |
| Location: |
New Jersey |
| Vaccinated: | 2021-06-01 |
| Onset: | 2021-06-26 |
| Days after vaccination: | 25 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-07-01 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 2 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Computerised tomogram thorax,
Limb discomfort,
Pain in extremity,
Thrombosis,
Ultrasound Doppler abnormal
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Cardiomyopathy (broad), Tendinopathies and ligament 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: Phenteramine
Current Illness: None
Preexisting Conditions: Obesity
Allergies: Rash to Amoxicillan
Diagnostic Lab Data: 6/29 upper extremity doppler 6/29 Chest CT
CDC Split Type:
Write-up: L distal internal jugular venous thrombus found on 6/29 after pt had three days of squeezing sensation on upper arm followed by acute pain on day of presentation to ED. In ED upper extremity Doppler demonstrated clot. Pt transferred to our hospital where she started on anticoagulation therapy for treatment. |
|
| VAERS ID: |
1460045 (history) |
| Form: |
Version 2.0 |
| Age: |
16.0 |
| Sex: |
Female |
| Location: |
Louisiana |
| Vaccinated: | 2021-06-14 |
| Onset: | 2021-06-21 |
| Days after vaccination: | 7 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-07-09 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EP7533 / 2 |
AR / IM |
Administered by: Private Purchased by: ?
Symptoms: Dysmenorrhoea,
Menstruation delayed,
Thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Fertility disorders (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Mydayis; Wellbutrin
Current Illness: No
Preexisting Conditions: No
Allergies: Augmentin, sulfa
Diagnostic Lab Data: No
CDC Split Type: vsafe
Write-up: She started her menstrual 10 days late with heavy clots and cramps which is abnormal. When she went to her 16 yr old well visit on 7/17 we informed her PCP of the concerns. |
|
| VAERS ID: |
1461717 (history) |
| Form: |
Version 2.0 |
| Age: |
15.0 |
| Sex: |
Female |
| Location: |
Michigan |
| Vaccinated: | 2021-06-24 |
| Onset: | 2021-06-25 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-07-09 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EW0150 / 2 |
RA / SYR |
Administered by: School Purchased by: ?
Symptoms: Asthenia,
Blood test,
Haemoglobin decreased,
Heavy menstrual bleeding,
Menstrual disorder,
Pallor,
Syncope,
Thrombosis,
Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Haematopoietic erythropenia (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
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: n/a
Diagnostic Lab Data: Blood work (Hemoglobin) taken on June 28 (10.3), June 29 (9?), July 3 (7.3), July 7 (8).
CDC Split Type:
Write-up: Abnormal menstrual cycle started on June 25, the day after dose 2; she already had a period June 10-16. This involved increasingly heavy bleeding, with large blood clots. My daughter became very pale, weak on the morning of Mon, June 28, she fainted, then vomited. Made dr appt and got bloodwork. Started her on iron supplements. Dr said the hemoglobin was at 10.6, but had us get blood checked 3 more times, lowest hemoglobin was at 7.3. |
|
| VAERS ID: |
1463786 (history) |
| Form: |
Version 2.0 |
| Age: |
15.0 |
| Sex: |
Female |
| Location: |
Michigan |
| Vaccinated: | 2021-06-22 |
| Onset: | 2021-07-11 |
| Days after vaccination: | 19 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-07-12 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EW0217 / 1 |
- / IM |
Administered by: Pharmacy Purchased by: ?
Symptoms: Angiogram cerebral,
Arteriogram carotid,
Cerebral venous sinus thrombosis,
Computerised tomogram head,
Haemorrhage intracranial,
Seizure
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Haemorrhagic central nervous system vascular conditions (narrow), Convulsions (narrow), Embolic and thrombotic events, venous (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Central nervous system vascular disorders, not specified as haemorrhagic or ischaemic (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Sprintec
Current Illness: NONE
Preexisting Conditions: PCOS
Allergies:
Diagnostic Lab Data: CT HEAD, CTA HEAD/NECK
CDC Split Type:
Write-up: Venous Sinus Thrombosis, Intracranial Hemorrhage, Seizure |
|
| VAERS ID: |
1464846 (history) |
| Form: |
Version 2.0 |
| Age: |
17.0 |
| Sex: |
Female |
| Location: |
Arizona |
| Vaccinated: | 2021-04-14 |
| Onset: | 2021-05-01 |
| Days after vaccination: | 17 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-07-12 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
ER2613 / 2 |
- / IM |
Administered by: Other Purchased by: ?
Symptoms: Anticoagulant therapy,
Chest pain,
Cough,
Deep vein thrombosis,
Haemoptysis,
Intensive care,
Pain in extremity,
Peripheral swelling,
Positron emission tomogram abnormal,
Pulmonary embolism,
Skin discolouration,
Thrombosis
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: NKMA
Diagnostic Lab Data: See above Can contact mother for more information.
CDC Split Type:
Write-up: First vaccine 3/24/21 Second vaccine 4/14/21 In early may, mom can''t remember date, patient c/o left leg and foot pain. Went to podiatrist - no diagnosis made - was told to monitor. Mid to late May developed dry cough. Not seen for this. On June 10 taken to ED lower left leg extremely painful and swollen and mom reported discoloration to back of leg. Diagnosed with DVT and put on blood thinner Xeralto and discharged. A week later went to hematologist who said to continue Xeralto and monitor. A week after seeing Dr. and two weeks after initial ED visit, on a Wednesday, patient started to cough up blood. Went back to Dr. and patient was taken off of Xeralto. PE scan ordered. The next day patient developed chest pain and went to ED. PE scan done and diagnosed with two PE''s on right lung. Was informed had six blood clots in lower left leg. Admitted to ICU. Was an inpatient for 5 days then discharged. Now patient is taking Lovenox injections twice daily. |
|
| VAERS ID: |
1487514 (history) |
| Form: |
Version 2.0 |
| Age: |
19.0 |
| Sex: |
Female |
| Location: |
South Carolina |
| Vaccinated: | 2021-05-21 |
| Onset: | 2021-07-06 |
| Days after vaccination: | 46 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-07-20 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN |
- / 1 |
LA / SYR |
Administered by: Pharmacy Purchased by: ?
Symptoms: Thrombosis,
Ultrasound Doppler abnormal
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Cardiomyopathy (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Sprintec birth control pills
Current Illness: None
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data: Ultrasound was given to locate clot
CDC Split Type:
Write-up: Blood clot in left leg |
|
| VAERS ID: |
1498693 (history) |
| Form: |
Version 2.0 |
| Age: |
17.0 |
| Sex: |
Female |
| Location: |
Washington |
| Vaccinated: | 2021-07-06 |
| Onset: | 2021-07-23 |
| Days after vaccination: | 17 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-07-23 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / UNK |
- / - |
Administered by: Unknown Purchased by: ?
Symptoms: Chest X-ray,
Computerised tomogram,
Dyspnoea,
Electrocardiogram,
Fibrin D dimer,
Pulmonary thrombosis
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Birth control pills, paxil
Current Illness: none
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data: Blood work ( D-Dimer) Chest xray, CT scan EKG
CDC Split Type:
Write-up: Blood clots near / in lungs, shortness of breath |
|
| VAERS ID: |
1500622 (history) |
| Form: |
Version 2.0 |
| Age: |
16.0 |
| Sex: |
Male |
| Location: |
Nevada |
| Vaccinated: | 2021-05-20 |
| Onset: | 2021-07-06 |
| Days after vaccination: | 47 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-07-24 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EW0186 / 2 |
LA / - |
Administered by: Unknown Purchased by: ?
Symptoms: Cerebral haemorrhage,
Cerebral thrombosis,
Cerebrovascular accident,
SARS-CoV-2 test
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), COVID-19 (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: TYLENOL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: ADHD
Allergies:
Diagnostic Lab Data: Test Date: 20210706; Test Name: Nasal Swab for COVID-19; Test Result: Negative
CDC Split Type: USPFIZER INC2021868587
Write-up: Clot and bleed in brain causing stroke; Clot and bleed in brain causing stroke; Clot and bleed in brain causing stroke; This is a spontaneous report from a contactable consumer (patient''s parent). A 16-year-old male patient received BNT162B2 (Lot Number: EW0186), dose 2 via an unspecified route of administration, administered in arm left on 20May2021 11:30 as single dose for covid-19 immunisation. Medical history included attention deficit hyperactivity disorder (ADHD). No known allergies. Concomitant medication included paracetamol (TYLENOL). The patient previously received first dose of BNT162B2 (lot number: ER8735) in left arm on 29Apr2021 17:15 for covid-19 immunisation. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. The patient experienced clot and bleed in brain causing stroke on 06Jul2021 17:00. The events were reported as serious due to hospitalization. Events resulted in: doctor or other healthcare professional office/clinic visit, emergency room/department or urgent care, hospitalization. Treatment received for the adverse events: Current hospitalization in PICU, rehabilitation, and pending further follow up actions. Prior to vaccination, was the patient diagnosed with COVID-19. The patient underwent lab tests and procedures which included nasal swab for Covid-19: negative on 06Jul2021. The outcome of events was recovering. |
|
| VAERS ID: |
1505464 (history) |
| Form: |
Version 2.0 |
| Age: |
17.0 |
| Sex: |
Male |
| Location: |
Massachusetts |
| Vaccinated: | 2021-04-24 |
| Onset: | 2021-04-27 |
| Days after vaccination: | 3 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-07-27 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
- / IM |
Administered by: Private Purchased by: ?
Symptoms: Deep vein thrombosis,
Ultrasound scan
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Infectious mononucleosis diagnosed on 4/4/2021
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Sonogram on 4/27/2021
CDC Split Type:
Write-up: Right leg deep vein thrombosis |
|
| VAERS ID: |
1510444 (history) |
| Form: |
Version 2.0 |
| Age: |
16.0 |
| Sex: |
Male |
| Location: |
Arizona |
| Vaccinated: | 2021-07-27 |
| Onset: | 2021-07-27 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-07-28 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
FA7484 / 2 |
LA / SYR |
Administered by: Private Purchased by: ?
Symptoms: Blood test normal,
Chromaturia,
Fear,
Haematuria,
Thrombosis,
Urine analysis
SMQs:, Rhabdomyolysis/myopathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Tubulointerstitial diseases (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Nazel stuffiness approx. two weeks ago
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: The medical team that was assisting my son, tested his urine and found Microscopic Hematuria-at that point his urine sample was back to normal color by the naked eye. They also decided to do a blood test and the results came back normal.
CDC Split Type:
Write-up: After my son received his 2nd Dose of the Pfizer on the scheduled date at approx.10:45 am, we went home and were just relaxing and at approx 1:54 pm. My son in a panic yelled for me to come into the bathroom and he showed me his urine and it was bright red with clots (Gross Hematuria). I know the time because as soon as I saw it I took a picture (of which I still have on my phone). I proceeded to access how he was feeling and after he said he felt okay just scared-no pain or anything, I called his Pediatrician whose office instructed me to take him to the ER and that is what I did. He was not rough housing, there was no trauma and again no pain. This has never happened before. |
|
| VAERS ID: |
1513430 (history) |
| Form: |
Version 2.0 |
| Age: |
15.0 |
| Sex: |
Female |
| Location: |
Montana |
| Vaccinated: | 2021-06-23 |
| Onset: | 2021-07-18 |
| Days after vaccination: | 25 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-07-29 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EW0169 / 2 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Activated partial thromboplastin time prolonged,
Anticoagulant therapy,
Axillary vein thrombosis,
Basophil count,
Blood creatinine normal,
Blood electrolytes normal,
Blood fibrinogen decreased,
Blood glucose normal,
Blood lactic acid normal,
Blood magnesium normal,
Blood urea nitrogen/creatinine ratio,
Blood urea normal,
Brachiocephalic vein thrombosis,
Discomfort,
Erythema,
Full blood count normal,
Haematocrit normal,
Haemoglobin normal,
Immature granulocyte count,
International normalised ratio normal,
Limb discomfort,
Liver function test normal,
Lymphocyte count,
Metabolic function test abnormal,
Monocyte count,
Neutrophil count,
Peripheral swelling,
Platelet count normal,
Pregnancy test urine negative,
Prothrombin time normal,
Thrombolysis,
Ultrasound Doppler abnormal,
Venogram abnormal,
White blood cell count normal
SMQs:, Cardiac failure (broad), Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage laboratory terms (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: scoliosis
Allergies: none
Diagnostic Lab Data: Ultrasound. Venogram. PTT 7/22/21 @ 0429-7/23/21 @ 4149: 115.5, 96.3, 39, 48.8, 47.6, 50.6, 43.5, 41.9 Fibrinogen 7/22/21 @ 1757-7/23/21 @ 1351: 282, 217, 147, 150, 154, 153 7/21/21 CBC: Normal. WBC 7.95, Hgb 13.2, Hematocrit 38.4, Plts 197 ANC 5.33, ALC 1.83, AMC 0.42, AEC 0.33, Absolute basophils 0.03, Imm Grans 0.01 K/mcL 7/21/21 PTT: Normal at 32.3 seconds 7/21/21 PT/INR: Normal at 14.1 and 1.16 7/21/21 CMP: Normal other than mildly increased BUN/Creatinine ratio of 25 (BUN 16, Crt 0.65). Liver enzymes normal. Electrolytes and glucose normal. 7/21/21 Mg: normal at 2.0 7/21/21 Lactate: Normal at 1.1 7/22/21 UPT: Negative
CDC Split Type:
Write-up: Presented with right arm redness and swelling. Ultrasound evaluation reveal DVT. Underwent heparinization and thrombolysis. Underwent post thrombolysis venogram. Patient is a 15 year old previously healthy female with unprovoked thrombosis located in right upper extremity, per the Admission Note specifically at the right distal subclavian through axillary vein as well as a DVT in the basilic and proximal brachial vein. Associated symptom was sensation of pressure on right arm "like blood pressure" cuff. Duration as of admission of these symptoms and presumably underlying clot was three days with onset of these symptoms was Sunday 7/18/2021. Timing was cyclical with discomfort in the arm worse in the morning than in the evening. Context of this thrombosis was healthy female who does not smoke, does not use hormonal contraception, is not active in sports where upper body workouts are emphasized, and was not injured. |
|
| VAERS ID: |
1520184 (history) |
| Form: |
Version 2.0 |
| Age: |
16.0 |
| Sex: |
Male |
| Location: |
Oregon |
| Vaccinated: | 2021-06-21 |
| Onset: | 2021-06-23 |
| Days after vaccination: | 2 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-08-02 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 2 |
- / IM |
Administered by: Private Purchased by: ?
Symptoms: Basilar artery thrombosis,
Intensive care,
Ischaemic stroke,
Mental status changes,
Nausea
SMQs:, Acute pancreatitis (broad), Ischaemic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: 100 mg sertraline daily sumatriptan abortive agent no herbal or dietary supplements
Current Illness: None
Preexisting Conditions: Dx of depression currently under control taking sertraline Dx of migraine takes sumatriptan abortive agent
Allergies: none
Diagnostic Lab Data: Admission to Pediatric ICU
CDC Split Type:
Write-up: Pt presented with nausea and altered mental status, imaging confirmed a R pons ischemic stroke, later found to be due to basilar artery thrombosis |
|
| VAERS ID: |
1534766 (history) |
| Form: |
Version 2.0 |
| Age: |
16.0 |
| Sex: |
Female |
| Location: |
Wisconsin |
| Vaccinated: | 2021-04-28 |
| Onset: | 2021-07-26 |
| Days after vaccination: | 89 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-08-07 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 2 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Dysmenorrhoea,
Heavy menstrual bleeding,
Menstrual disorder,
Thrombosis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (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: at 9 y.o. chicken pox vacc: pneumonia and cellulitis
Other Medications: Meningitis vacc on 6/4/2021 hycosamine
Current Illness: IBS
Preexisting Conditions: IBS
Allergies: gluten sensitive
Diagnostic Lab Data: n/a
CDC Split Type: ?
Write-up: 7/26/2021 had insanely heavy menstrual cycle that was soaking pads within an hour (normal is ~4-5 hours). She had cramps that she has never experienced before 7/26 eve and 7/27 daytime. There were large blood clots present ($g$g quarter size) 7/26-7/28. Normally only small clots. First heavy point of 1 hour soaks were 6am-11am on 7/26. Then was medium changing 3-5 hours until 7pm. Then became insanely heavy again until 10pm with pad change out at 2 hours. 7/27 normal medium flow but every hour change outs that night. Other days back to a normal routine of medium and light |
|
| VAERS ID: |
1535431 (history) |
| Form: |
Version 2.0 |
| Age: |
17.0 |
| Sex: |
Female |
| Location: |
New Jersey |
| Vaccinated: | 2021-05-14 |
| Onset: | 2021-07-23 |
| Days after vaccination: | 70 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-08-08 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EW0170 / 1 |
AR / IM |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EW0182 / 2 |
AR / IM |
Administered by: Pharmacy Purchased by: ?
Symptoms: Anticoagulant therapy,
Antiphospholipid antibodies negative,
Antithrombin III,
Aphasia,
Apraxia,
Beta-2 glycoprotein antibody negative,
Blood homocysteine increased,
Blood iron normal,
Bradycardia,
Cardiolipin antibody,
Cerebral haemorrhage,
Cerebral mass effect,
Cerebral venous thrombosis,
Coagulation factor VIII level increased,
Computerised tomogram head,
Decompressive craniectomy,
Drain placement,
Echocardiogram,
Echocardiogram normal,
Generalised tonic-clonic seizure,
Haematocrit normal,
Haemoglobin normal,
Headache,
Hemiparesis,
Human chorionic gonadotropin negative,
Iron binding capacity total decreased,
Laboratory test normal,
Lipoprotein (a) normal,
Magnetic resonance imaging head abnormal,
Mean cell volume normal,
Protein C,
Protein S,
SARS-CoV-2 antibody test negative,
Thrombotic cerebral infarction,
Tongue paralysis,
Transferrin saturation decreased,
Ultrasound Doppler,
Ultrasound scan normal
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Convulsions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Thrombophlebitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), COVID-19 (broad)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 19 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Of note, pt mother hx 1 episode of DVT/PE w/ first pregnancy and 1 miscarriage (unknown GA) after 2nd pregnancy. Pt not on OCPs 07/23: MRI/CT: L vein of Labbe occlusion w/ L temporal lobe infarct w/ inferior parietal lobe infarct w/ minor hemorrhage w/ midline shift 07/23: Hcg: Neg 07/24: LE duplex - normal 07/26: Factor V mutation absent, Factor VIII 173%, Protein C 29%, Protein S 83%, Absent Prothrombin gene mutation, Lupus anticoagulant negative, ATIII 51% -- $g 87% (07/29), B2 glycoprotein IgG/IgM <9.4 07/26: COVID nucleocapsid neg, COVID spike antibody 2126 07/27: TTE w/ bubble - normal study no PFO 07/27: lipoprotein A <6, cardiolipin IgG 6, cardiolipin IgM 24.5, homocysteine 3.0, negative heparin associated antibody 07/28: Hb 9.7, MCV 72.3, Hct 31.8, Fe 14, TIBC 223, % sat 6
CDC Split Type:
Write-up: Pt admitted on 07/23 w/ hx of headache for 5 days and GTC on day of admission, found to have L vein of Labbe thrombosis complicated by L temporal lobe infarct extending into the left inferior parietal lobe w/ minor hemorrhage in infarct. Pt started on heparin gtt but still developed midline shift and bradycardia, so was send for decompressive L. hemicrani w/ subglaeal hemovac placement on 07/24. After sx, patient had persistent R hemiparesis w/ R tongue deviation and profound expressive aphasia w/ some evidence of apraxia. Pt then managed w/ lovenox for AC, keppra for seizure ppx as well as PT/OT/ST for improving strength and language. Pt expected discharge to acute rehab on 08/11. |
|
| VAERS ID: |
1549292 (history) |
| Form: |
Version 2.0 |
| Age: |
19.0 |
| Sex: |
Female |
| Location: |
Texas |
| Vaccinated: | 2021-06-30 |
| Onset: | 2021-07-17 |
| Days after vaccination: | 17 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-08-12 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
RA / SYR |
Administered by: Pharmacy Purchased by: ?
Symptoms: Peripheral swelling,
Thrombosis
SMQs:, Cardiac failure (broad), Angioedema (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Epidiolex , Alprazolam,Trazodone
Current Illness: Epilepsy. Anxiety
Preexisting Conditions: Trisonometry 18
Allergies: none
Diagnostic Lab Data: Blood Clot
CDC Split Type:
Write-up: Swelling Right Leg |
|
| VAERS ID: |
1549546 (history) |
| Form: |
Version 2.0 |
| Age: |
19.0 |
| Sex: |
Female |
| Location: |
Florida |
| Vaccinated: | 2021-03-13 |
| Onset: | 2021-03-14 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-08-12 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EN6206 / 1 |
LA / IM |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
ER8734 / 2 |
LA / IM |
Administered by: Other Purchased by: ?
Symptoms: Arthralgia,
Fatigue,
Feeling abnormal,
Heavy menstrual bleeding,
Joint stiffness,
Skin exfoliation,
Thrombosis,
Vaccine positive rechallenge,
Vaginal discharge
SMQs:, Severe cutaneous adverse reactions (broad), Haemorrhage terms (excl laboratory terms) (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Q-var (asthma) Fexofenadine (allergies) Vit D Zinc Fish OIl Daily Vitamin
Current Illness: None
Preexisting Conditions: Asthma Anaphylactic to Peanuts
Allergies: Peanuts (anapjhylactic) Wheat (not anaphylactic) Dairy (not anaphylactic)
Diagnostic Lab Data: None
CDC Split Type:
Write-up: *Menstrual Cycle: Abnormal cycles. The second dose coincided with the start of menstrual bleeding, cycles are normally 5-7 days. This one lasted 13, with clotting and watery, brown discharge for four days at the end. Next cycle was also mild clotting. Has resolved. *Fatigue: started day after dose 1, lasted for 3 days; started again day after dose 2 and lasted for 2+ months. Especially noticed after moderate exercise. Not normal fatigue, it was like she had been out in the sun too long and was exhausted. It took the rest of the day+ to resolved with each instance. *Hollow-head: 5 days post dose 1; worse after dose 2, lasted about 1 week. Not your normal light-headedness. It felt like it was made of stone and filled with helium. Lots of ''empty space'' but hard and heavy. *Joint pain and stiffness: started day after dose 1, lasted 4-5 days; started day after dose 2 and has not resolved as of today (8.12.2021) *Peeling feet: both heels of feet and bottoms of toes peeled June 20th-June23rd, completely. I (mom) wouldn''t have thought about this being a side effect, except I belong to a adverse event vaccine group myself and see this reported frequently by people who have had worse reactions. |
|
| VAERS ID: |
1578185 (history) |
| Form: |
Version 2.0 |
| Age: |
17.0 |
| Sex: |
Female |
| Location: |
New York |
| Vaccinated: | 2021-06-09 |
| Onset: | 2021-06-10 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-08-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EW0175 / 1 |
LA / SYR |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EN0217 / 2 |
LA / SYR |
Administered by: Other Purchased by: ?
Symptoms: Diarrhoea,
Dysmenorrhoea,
Influenza,
Insomnia,
Thrombosis
SMQs:, Pseudomembranous colitis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Infective pneumonia (broad), Opportunistic infections (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Patient took first Vaccine on 5/19/2021. The day after she was experiencing flu symptoms. When the patient cycles started it was extremely painful. She was in bed for three days due to the pain. The Second vaccine was given on 6/09/2021. Patient had flu symptoms again. When her cycle started she had blood clots, and loose stool. Patient was very active, now all she wants to do is stay on bed. When patient is on her cycle she can not sleep from the pain. |
|
| VAERS ID: |
1623532 (history) |
| Form: |
Version 2.0 |
| Age: |
16.0 |
| Sex: |
Male |
| Location: |
Michigan |
| Vaccinated: | 2021-05-12 |
| Onset: | 2021-06-29 |
| Days after vaccination: | 48 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-08-23 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 2 |
AR / IM |
Administered by: Public Purchased by: ?
Symptoms: Condition aggravated,
Epistaxis,
Influenza like illness,
Injection site pain,
Malaise,
Pyrexia,
Thrombosis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Extravasation events (injections, infusions and implants) (broad), 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? No
Hospitalized? No
Previous Vaccinations: Childhood vaccines caused some adverse reactions such as fever, malaise, diarrhea
Other Medications: None
Current Illness: None
Preexisting Conditions:
Allergies: Unaware of any. Previous reactions to vaccinations, some food sensitivities.
Diagnostic Lab Data:
CDC Split Type:
Write-up: Within hours, feeling of malaise and sore at injection site. Developed a fever and was in a flu-like state for the next 4 days. This resolved. Although there is a history of mild nosebleeds due to dry weather, my child began having regular and hard to control nosebleeds after receiving the second dose. He is passing clots up to six inches in length and going through dozens of tissues to soak up the blood and clots. Bleeds are lasting roughly 15 minutes |
|
| VAERS ID: |
1623852 (history) |
| Form: |
Version 2.0 |
| Age: |
14.0 |
| Sex: |
Male |
| Location: |
Wisconsin |
| Vaccinated: | 2021-06-14 |
| Onset: | 2021-07-09 |
| Days after vaccination: | 25 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-08-23 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
UNKNOWN / UNK |
UN / SYR |
Administered by: Unknown Purchased by: ?
Symptoms: Cerebral venous sinus thrombosis,
Magnetic resonance imaging head abnormal,
Venogram abnormal
SMQs:, Embolic and thrombotic events, venous (narrow), Central nervous system vascular disorders, not specified as haemorrhagic or ischaemic (narrow)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: focalin during school year (unsure if was on during the time)
Current Illness: none
Preexisting Conditions: ADD In hospital ultimately found - Factor V Leiden heterozygote - variant 1691G$gA (c.1601G$gA)
Allergies: none
Diagnostic Lab Data: MRI brain/MRV with extensive clot burden
CDC Split Type:
Write-up: extensive cerebral sinus venous thrombosis |
|
| VAERS ID: |
1633335 (history) |
| Form: |
Version 2.0 |
| Age: |
19.0 |
| Sex: |
Female |
| Location: |
Florida |
| Vaccinated: | 2021-06-01 |
| Onset: | 2021-08-09 |
| Days after vaccination: | 69 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-08-25 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN |
204A21A / 1 |
LA / SYR |
Administered by: Pharmacy Purchased by: ?
Symptoms: Angiogram,
Angiogram abnormal,
Arthralgia,
Atelectasis,
Deep vein thrombosis,
Dyspnoea,
Echocardiogram abnormal,
Intracardiac thrombus,
Pain in extremity,
Pulmonary embolism,
Pulmonary pain,
Thrombosis
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Noninfectious myocarditis/pericarditis (broad)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Nuva ring birth control
Current Illness:
Preexisting Conditions: Irritable bowel syndrome, polycystic ovarian syndrome, asthma, fibromyalgia
Allergies: Dairy products
Diagnostic Lab Data: CTA on 8/20/21: multiple blood clots in left lung moderate to sever clot bourden. Echocardiogram on 8/21/21: small clot in heart. CTA on 8/23/21: clot bourden has lessened, showed fluid under left lung and bilateral lower lobe consolidation, likely atelectasis
CDC Split Type:
Write-up: Multiple DVTs is left arm axillary and basilic veins, multi clot pulmonary embolism in left lung and heart. Symptoms started as DVT pain in left fore arm early to mid 07/2021, shortness of breath started on 8/9/2021 and continued and worsened with left lung pain and right shoulder pain continuing and worsening, hospitalized on 8/20/2021 after CT showed multiple blood clots in the left lung with severe pain, hospitalized until 8/24/2021 still having symptoms of DVT after leaving hospital. |
|
| VAERS ID: |
1641021 (history) |
| Form: |
Version 2.0 |
| Age: |
16.0 |
| Sex: |
Female |
| Location: |
Texas |
| Vaccinated: | 2021-06-01 |
| Onset: | 2021-06-01 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-08-27 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 2 |
- / - |
Administered by: Private Purchased by: ?
Symptoms: Cerebral venous sinus thrombosis,
Dehydration,
Magnetic resonance imaging head abnormal,
Venogram abnormal
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Embolic and thrombotic events, venous (narrow), Central nervous system vascular disorders, not specified as haemorrhagic or ischaemic (narrow), Dehydration (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: OCP, spironolactone, and doxyxycline at home.
Current Illness: Acne and hx ovarian cyst
Preexisting Conditions: none
Allergies: NKDA
Diagnostic Lab Data: 6/16/21 MRI/MRV- Venous sinus thrombosis
CDC Split Type:
Write-up: New onset sinus venous thrombosis 15 days after 2nd dose of COVID19 vaccine. Patient did had other predisposing factors that include use of OCP, sinus issues since she is a swimmer, and dehydration at admission. |
|
| VAERS ID: |
1682808 (history) |
| Form: |
Version 2.0 |
| Age: |
17.0 |
| Sex: |
Male |
| Location: |
Unknown |
| Vaccinated: | 2021-07-12 |
| Onset: | 2021-07-18 |
| Days after vaccination: | 6 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-09-08 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
UNKNOWN / 1 |
UN / IM |
Administered by: Unknown Purchased by: ?
Symptoms: Chest pain,
Pulmonary embolism,
Vena cava thrombosis
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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? Yes, 3 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: -History of left iliofemoral deep venous thrombosis and pulmonary embolism in setting of May-Thurner anatomy & recent surgery in February 2020. Iliac stent placed in March 2020. -Depression and anxiety
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Patient developed chest pain approximately 6 days after receiving first dose of Pfizer vaccine. He presented to the ER on 7/23/21 (11 days after vaccine) and was found to have a pulmonary embolism and deep venous thrombosis in his inferior vena cava (IVC). |
|
| VAERS ID: |
1685612 (history) |
| Form: |
Version 2.0 |
| Age: |
19.0 |
| Sex: |
Female |
| Location: |
Tennessee |
| Vaccinated: | 2021-03-06 |
| Onset: | 2021-06-26 |
| Days after vaccination: | 112 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-09-09 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN |
1805029 / 1 |
LA / SYR |
Administered by: Pharmacy Purchased by: ?
Symptoms: Dizziness,
Headache,
Nausea,
Peripheral swelling,
Pulmonary thrombosis,
Pyrexia
SMQs:, Cardiac failure (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, venous (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), 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? Yes, 3 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: surtuleen , loryna, hydroxoline
Current Illness:
Preexisting Conditions:
Allergies: seasonal allergies and melons
Diagnostic Lab Data: blood clot on lung
CDC Split Type: vsafe
Write-up: swelling in left arm, headache, extreme dizziness, nausea, fever |
|
| VAERS ID: |
1693704 (history) |
| Form: |
Version 2.0 |
| Age: |
19.0 |
| Sex: |
Female |
| Location: |
California |
| Vaccinated: | 2021-05-08 |
| Onset: | 2021-05-23 |
| Days after vaccination: | 15 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-09-12 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / UNK |
- / - |
Administered by: Unknown Purchased by: ?
Symptoms: Autopsy,
Death,
Pulmonary thrombosis,
Toxicity to various agents
SMQs:, Anticholinergic syndrome (broad), Embolic and thrombotic events, venous (narrow), Drug abuse and dependence (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-05-23
Days after onset: 0
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: depression, anxiety
Allergies: none
Diagnostic Lab Data:
CDC Split Type:
Write-up: The decedent was found deceased at home on 05/23/2021. The decedent''s cause of death is acute fentanyl toxicity. The pathologist found blood clots in her lungs during autopsy, and she was concerned the blood clots may be related to the vaccine she received on 05/08/2021. |
|
| VAERS ID: |
1718354 (history) |
| Form: |
Version 2.0 |
| Age: |
15.0 |
| Sex: |
Male |
| Location: |
Illinois |
| Vaccinated: | 2021-08-11 |
| Onset: | 2021-08-31 |
| Days after vaccination: | 20 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-09-21 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
FC3180 / 2 |
LA / - |
Administered by: Pharmacy Purchased by: ?
Symptoms: Blood test,
Bradyphrenia,
Cerebrovascular accident,
Computerised tomogram,
Fatigue,
Feeling abnormal,
Headache,
Investigation,
Meningitis,
Pain,
Thrombosis,
Urine analysis
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Parkinson-like events (broad), Thrombophlebitis (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: ADHD (Verbatim: ADHD diagnosed at the end of sixth grade and he is sophomore in high school, so about 3.5 years ago)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: Blood works; Result Unstructured Data: Test Result:Unknown Result; Test Name: stroke; Result Unstructured Data: Test Result:negative; Test Name: CAT scan; Result Unstructured Data: Test Result:negative; Test Name: Mono; Result Unstructured Data: Test Result:negative; Test Name: meningitis; Result Unstructured Data: Test Result:negative; Test Name: Blood clots; Result Unstructured Data: Test Result:negative; Test Name: urinalysis; Result Unstructured Data: Test Result:negative; Comments: He also had urinalysis to check for diabetes.
CDC Split Type: USPFIZER INC202101211850
Write-up: When he bent over at the waist he had sharp pain across his forehead.; severe brain fog; inability to think clearly; Exhaustion; headache; This is a spontaneous report from a contactable consumer (mother) reported for male patient (son) that: A 15-years-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection), dose 2 via an unspecified route of administration, administered in Arm Left on 11Aug2021 (Batch/Lot Number: FC3180; Expiration Date: Oct2021) as DOSE 2, SINGLE for covid-19 immunization. The patient past Medical history included attention deficit hyperactivity disorder from 2018 and ongoing (ADHD), diagnosed at the end of sixth grade and he is sophomore in high school, so about 3.5 years ago. The Historical Vaccine include Comirnaty (1st dose) on 23Jul2021(lot number: EW0179/expiry date: Aug2021) for covid-19 immunization. The patient''s concomitant medications were not reported. The Family Medical History Relevant to AE(s): caller suffers from migraines, but she is not sure if it is relevant. Migraines are more sudden and don''t last days on end. His maternal grandfather had Meniere''s Disease and died of a heart attack at age 45. The patient did not receive any other vaccine within 4 weeks prior to covid-19 vaccination. She is not sure if that is relevant. She is calling to report a possible side effect the first day when he went to the school nurse for the sharp headache. When he bent over at the waist, he had sharp pain across his forehead. Severe brain fog, inability to think clearly, and Exhaustion: around Labor Day weekend about on 05Sep2021. when he told her that it was getting worse, and he wanted to see a doctor. He went to the doctor on 07Sep2021. Went to ER on 08Sep2021 and again to ER on 12Sep2021. He was not admitted to the hospital and was only treated in the emergency room and they were unable to find anything wrong. The patient underwent lab tests and procedures which included Investigations: Tested for Mono, Meningitis, blood clots, and stroke. He has had CAT scan and urinalysis to check for diabetes. All have been negative. The event outcome was unknown. |
|
| VAERS ID: |
1719060 (history) |
| Form: |
Version 2.0 |
| Age: |
14.0 |
| Sex: |
Male |
| Location: |
North Carolina |
| Vaccinated: | 2021-09-20 |
| Onset: | 2021-09-21 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-09-21 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
LA / IM |
Administered by: Unknown Purchased by: ?
Symptoms: Atrioventricular block complete,
Blood test,
Cerebral thrombosis,
Cerebrovascular accident,
Computerised tomogram,
Drooling,
Magnetic resonance imaging,
Mental status changes,
Speech disorder,
Thrombectomy
SMQs:, Conduction defects (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypokalaemia (broad), Noninfectious myocarditis/pericarditis (broad)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: CT, MRI, blood work
CDC Split Type:
Write-up: Student was drooling, and had an altered state. Speech was mumbled, student was able to smile and it was equal. Student''s heart rate was in the 50s, Sp02 98-99% , EMS/911 was called, student transported to hospital after monitor showed 3rd degree heartblock. EMS took student to hospital where a code stroke was called. student had a CT and an MRI, student then was taken to surgery to remove clot from brain. |
|
| VAERS ID: |
1737016 (history) |
| Form: |
Version 2.0 |
| Age: |
13.0 |
| Sex: |
Female |
| Location: |
Colorado |
| Vaccinated: | 2021-08-20 |
| Onset: | 2021-08-25 |
| Days after vaccination: | 5 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-09-27 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
FC3180 / 1 |
LA / IM |
Administered by: Unknown Purchased by: ?
Symptoms: Angiogram peripheral abnormal,
Anticoagulant therapy,
Antiphospholipid antibodies negative,
Asthenia,
Atrial thrombosis,
Beta-2 glycoprotein antibody negative,
Blood electrolytes normal,
Blood fibrinogen,
Blood homocysteine,
Cardiolipin antibody negative,
Catheterisation cardiac,
Echocardiogram abnormal,
Full blood count,
Haematocrit normal,
Haemoglobin normal,
Heart valve replacement,
Hypoaesthesia,
International normalised ratio increased,
Mitral valve incompetence,
Mitral valve stenosis,
Myxoma,
Pain in extremity,
Peripheral artery occlusion,
Peripheral artery thrombosis,
Platelet count normal,
Prothrombin time prolonged,
Pulse absent,
Right ventricular enlargement,
SARS-CoV-2 RNA undetectable,
Thrombectomy,
Thromboembolectomy,
Ultrasound Doppler abnormal,
White blood cell count increased
SMQs:, Cardiac failure (broad), Liver-related coagulation and bleeding disturbances (narrow), Peripheral neuropathy (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Pulmonary hypertension (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad), Sexual dysfunction (broad), Noninfectious myocarditis/pericarditis (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, 7 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None reported
Preexisting Conditions: asthma
Allergies: None reported
Diagnostic Lab Data: Labs: SARS-CoV-2: RNA: negative Electrolytes: within normal ranges Initial PT/INR on arrival from outside facility: 16.5 seconds/1.4 CBC: hemoglobin: 11.7 gm/dL, hematocrit: 34.5%, WBC: 14.2 10*9/L, platelets: 393 10*9/L Fibrinogen: 316 mg/dL Lupus anticoagulant, Beta-glycoprotein antibodies, Anti-Cardiolipin antibodies: within normal ranges Homocysteine: 4.1 umol/L Imaging: CTA: occlusive thrombus in left distal common femoral artery into proximal profunda; occlusive thrombus in right distal popliteal artery; non occlusive thrmbus extending into tibial peroneal trunk ECHO: echogenic structure in left atrium (myxoma), enlarged right ventricle, mitral valve stenosis and regurgitation
CDC Split Type:
Write-up: Pfizer-BioNTech COVID-19 Vaccine EUA: patient presented to another hospital with sudden onset left leg pain, numbness, and weakness during athletic activity. No Doppler pedal pulse detected and transferred to this facility. Found to have occlusions on left CFA, right profunda, and right popliteal as well as a left atrial mass (myxoma), left atrial thrombus, and mitral insufficiency. Admitted, anticoagulated, and underwent balloon embolectomies, mechanical valve replacement, right heart catheterizations, and thrombectomies. Discharged to home stable on anticoagulation with cardiology follow-up in place. |
|
| VAERS ID: |
1742387 (history) |
| Form: |
Version 2.0 |
| Age: |
19.0 |
| Sex: |
Female |
| Location: |
Wisconsin |
| Vaccinated: | 2021-08-24 |
| Onset: | 2021-09-08 |
| Days after vaccination: | 15 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-09-28 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
FC3183 / 1 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Anticoagulant therapy,
Back pain,
Laboratory test abnormal,
Pain in extremity,
Stent placement,
Thrombectomy,
Thrombosis
SMQs:, Retroperitoneal fibrosis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Tendinopathies and ligament disorders (broad)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: birth control
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Transfer of three hospitals to meet patient needs. Labs - thrombectomy - stents placement - lifetime medication
CDC Split Type:
Write-up: Paint to back and leg - Showered blood clots - result hospitalization with continuous heparin drip - daily thrombectomy- stents placed - on Xarelto for lifetime |
|
| VAERS ID: |
1749892 (history) |
| Form: |
Version 2.0 |
| Age: |
17.0 |
| Sex: |
Female |
| Location: |
Massachusetts |
| Vaccinated: | 2021-05-20 |
| Onset: | 2021-06-11 |
| Days after vaccination: | 22 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-09-30 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EW0177 / 2 |
LA / IM |
Administered by: Pharmacy Purchased by: ?
Symptoms: Computerised tomogram,
Deep vein thrombosis,
Pulmonary embolism,
Ultrasound Doppler,
Ultrasound scan
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (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, 2 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Apri, Lamictal, Fluoxetine, Quetiapine
Current Illness: None
Preexisting Conditions: Depression , anxiety and obesity
Allergies: Amoxicillin
Diagnostic Lab Data: doppler sonogram and CT scan
CDC Split Type:
Write-up: deep vein thrombosis and pulmonary embolism |
|
| VAERS ID: |
1772573 (history) |
| Form: |
Version 2.0 |
| Age: |
13.0 |
| Sex: |
Male |
| Location: |
Iowa |
| Vaccinated: | 2021-09-04 |
| Onset: | 2021-09-16 |
| Days after vaccination: | 12 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-10-08 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EW0170 / 1 |
RA / IM |
Administered by: Pharmacy Purchased by: ?
Symptoms: Fibrin D dimer,
Thrombosis,
Ultrasound scan abnormal
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (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: aripiprazole 5mg, hydroxyzine 50mg, citalopram 40mg, alprazolam 0.5 mg
Current Illness:
Preexisting Conditions:
Allergies: penicillins
Diagnostic Lab Data: d-dimer 0.75, ultrasound showed clot
CDC Split Type:
Write-up: Developed clot in lower leg (shin), 60 mg Lovenox at ER, 81 mg aspirin daily, cephalexin 500 mg three times a day for 10 days, smz/tmp 800mg/160mg twice daily for 3 days |
|
| VAERS ID: |
1793576 (history) |
| Form: |
Version 2.0 |
| Age: |
17.0 |
| Sex: |
Female |
| Location: |
Minnesota |
| Vaccinated: | 2021-05-18 |
| Onset: | 2021-10-13 |
| Days after vaccination: | 148 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-10-16 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / UNK |
- / - |
Administered by: Private Purchased by: ?
Symptoms: Computerised tomogram abdomen,
Computerised tomogram thorax abnormal,
Echocardiogram,
Fibrin D dimer,
Pulmonary embolism,
Ultrasound Doppler,
Vena cava thrombosis,
Venogram
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Cardiomyopathy (broad)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: diabetes
Preexisting Conditions: diabetes
Allergies: none
Diagnostic Lab Data: CT PR chest and abdomen 10-12-2021 echocardiogram 10-12-2021 bilat leg doppler, 10-12-2021 ct venogram 10-13-2021 d-dimer 10-12-2021
CDC Split Type:
Write-up: saddle pulmonary emboli, IVC clot |
|
| VAERS ID: |
1793662 (history) |
| Form: |
Version 2.0 |
| Age: |
17.0 |
| Sex: |
Female |
| Location: |
Tennessee |
| Vaccinated: | 2021-09-12 |
| Onset: | 2021-10-03 |
| Days after vaccination: | 21 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-10-16 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 2 |
LA / SYR |
Administered by: Unknown Purchased by: ?
Symptoms: Chest pain,
Cough,
Headache,
Oropharyngeal pain,
Respiratory tract congestion,
Sinus congestion,
Sneezing,
Throat irritation,
Thrombosis
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Thrombophlebitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (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: sertraline 25mg, Hydroxyzine 25mg, Drospirenone 3/0.02 mg,
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:
Write-up: sinus and chest congestion turned into blood clots in mucus and minor headaches. scratchy/ sore throat, sneezing, slight coughing (cough 5x a day at max), and slight chest pain when laying down |
|
| VAERS ID: |
1796183 (history) |
| Form: |
Version 2.0 |
| Age: |
19.0 |
| Sex: |
Female |
| Location: |
California |
| Vaccinated: | 2021-08-17 |
| Onset: | 2021-10-07 |
| Days after vaccination: | 51 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-10-18 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER |
- / 1 |
- / SYR |
Administered by: Pharmacy Purchased by: ?
Symptoms: Computerised tomogram abnormal,
Scan with contrast,
Thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (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: No
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: Went to the ER they did a CT scan with contrast dye and found blood clot on 10/17/2021
CDC Split Type:
Write-up: Now has a blood clot. |
|
| VAERS ID: |
1798966 (history) |
| Form: |
Version 2.0 |
| Age: |
12.0 |
| Sex: |
Male |
| Location: |
Illinois |
| Vaccinated: | 2021-09-30 |
| Onset: | 2021-09-30 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-10-19 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / UNK |
- / - |
Administered by: Unknown Purchased by: ?
Symptoms: Blood test,
Computerised tomogram abnormal,
Feeling abnormal,
Omental infarction,
Pain,
Thrombosis,
X-ray
SMQs:, Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-ray and CT Blood work
CDC Split Type:
Write-up: He got his 2nd dose around 3 pm. Around 7 pm he was feeling really bad. He said his right side was hurting. He was still hurting in the morning and I notified his doctor. His doctor did a CT scan and found a blood clot. Omentum Infarct. I don?t know if it?s related or not. I just thought the timing of it was pretty close and I should pass the info on. |
|
| VAERS ID: |
1809213 (history) |
| Form: |
Version 2.0 |
| Age: |
18.0 |
| Sex: |
Male |
| Location: |
New Hampshire |
| Vaccinated: | 2021-09-27 |
| Onset: | 2021-10-19 |
| Days after vaccination: | 22 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-10-22 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / UNK |
- / - |
Administered by: Private Purchased by: ?
Symptoms: Abdominal pain,
Angiogram pulmonary abnormal,
Anticoagulant therapy,
Antinuclear antibody negative,
Blood homocysteine normal,
Brain natriuretic peptide normal,
Chest X-ray normal,
Compartment syndrome,
Coronary angioplasty,
Cough,
Deep vein thrombosis,
Dizziness,
Dyspnoea,
Dysuria,
Electrocardiogram normal,
Exposure to SARS-CoV-2,
Fibrin D dimer normal,
Gait disturbance,
Gene mutation identification test negative,
Hypoaesthesia,
Laboratory test,
Leukocytosis,
Liver function test increased,
Magnetic resonance imaging abdominal normal,
Metabolic function test,
Myalgia,
Pain in extremity,
Peripheral swelling,
Platelet factor 4,
Polyuria,
Pulmonary embolism,
Pyrexia,
SARS-CoV-2 antibody test,
SARS-CoV-2 test negative,
Skin discolouration,
Tachycardia,
Thrombectomy,
Troponin,
Ultrasound Doppler abnormal
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Parkinson-like events (broad), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Other ischaemic heart disease (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Tubulointerstitial diseases (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad), COVID-19 (narrow), Sexual dysfunction (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: none
Current Illness: Patient started having COVID symptoms (cough, subjective fevers, muscle aches) since 9/28 (despite a negative rapid COVID test on 9/27, at that time, he received the first dose of Pfizer). Patient''s mom and sister were all tested positive for COVID on the 27th.
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: as above
CDC Split Type:
Write-up: Patient is an 18 year-old male with recent COVID symptoms for about 2 weeks who presented as a transfer from a small Hospital for further management of extensive DVT c/f phlegmasia cerulea dolens and early compartment syndrome. Patient started having COVID symptoms (cough, subjective fevers, muscle aches) since 9/28 (despite a negative rapid COVID test on 9/27, at that time, he received the first dose of Pfizer). Patient''s mom and sister were all tested positive for COVID on the 27th. Patient had been essentially bedridden for 2-3 weeks due to his COVID symptoms. Pt. started limping and experiencing some right leg pain/soreness about a week and half ago and went to see his PCP and was given Mucinex for residual cough and Tylenol for leg pain. Three days ago, the pain migrated to the left leg and the pain was initially intermittent, then became constant 10/10 pain associated with significant swelling and "left foot turning purple and numb" which prompted the patient to go to the ED. Patient also endorses intermittent cough, dizziness, mild SOB, mild abdominal pain, dysuria and polyuria, denies any trauma or falls, chest pain, headache, fever/chils, diarrhea. Patient lives with mom, younger sister, home school, plays soccer. Vaccines are up to date. Of note, pt. has been getting weekly and then monthly blood work at his PCP''s office for a workup of his severe abdominal pain that started 4-5 months ago c/f liver & kidney disease, MRI of the abdomen was done and unremarkable. Per mom, PCP wants to have a series of labs (not sure what labs were drawn) before referring the patient bigger hospital. At the hospital, pt. was given morphine q1h for pain, heparin bolus x2, on heparin drip 1200units/hr and mIVF. Pt. remained afebrile and hemodynamically stable, slightly tachycardia, but normotensive, no hypoxia. He has slight increase in his LFTs and a mild leukocytosis. Chest x-ray is unremarkable, EKG is nonischemic with no significant demand. Ultrasound of left lower extremity shows extensive deep venous thrombosis from groin to toe. Proximal vasculature obscured by overlying bowel gas. CTA of the chest shows bilateral basilar pulmonary emboli. Troponin was undetectable and BNP was only 25. Hospital Course #Cardiovascular: patient was started on heparin drip. Vascular surgery was consulted and recommended thrombectomy for his extensive DVTs in the setting of early compartment syndrome. S/P urgent Left common iliac, external iliac, femoral, and popliteal vein mechanical thrombectomy with ClotTriever system and left CFV balloon angioplasty (10/19). Due to difficulty in achieving a therapeutic anti Xa while on heparin drip, heparin drip was discontinued and patient was started on Xarelto BID PO. Hematology was consulted and they recommended baseline LFTs and chem 10 prior to starting Xarelto which came back WNL. Obtain coags including fibrinogen (normal) and D-dimer(elevated), lupus anticoagulant assay, Factor V Leiden, prothrombin gene mutation, and homocysteine levels (negative). #Resp: Small bilateral PEs was found at OSH CTA, but pt. has been sating well and remained on RA throughout admission. #FENGI: Pt. was made NPO with mIVF on 10/19 from the thrombectomy. Resumed regular diet afterwards #Neuro: Pt.''s pain has been managed with morphine q2h PRN and Tylenol q6h PRN. Please avoid NSAIDs. Patient discharged with only Tylenol prn for pain. #Hem: Hematology team was consulted and they recommended labs to rule out hypercoagulability (anti thrombin gene mutation, lupus anticoagulant assay, homocysteine, and factor V Leiden). LFTs and chem10 were checked before starting rivaroxaban and it was WNL. He should f/u with pedi heme/onc on 11/8. #ID: rapid COVID 3 weeks ago negative. We discussed with ID the role of antibody testing to help differentiate if clot may be related to COVID versus possible vaccine-related complication. COVID nucleocapsid and PF4 antibody testing sent(pending). Patient should hold off on getting the booster. Patient worked with PT while inpatient. He is safe to go home but will need PT at home. |
|
| VAERS ID: |
1817231 (history) |
| Form: |
Version 2.0 |
| Age: |
18.0 |
| Sex: |
Male |
| Location: |
New Hampshire |
| Vaccinated: | 2021-05-12 |
| Onset: | 2021-09-01 |
| Days after vaccination: | 112 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-10-26 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
022D21A / 1 |
- / OT |
Administered by: Unknown Purchased by: ?
Symptoms: Mobility decreased,
Muscular weakness,
Pain in extremity,
Thrombosis,
Vaccination site swelling
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Parkinson-like events (broad), Thrombophlebitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Tendinopathies and ligament 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: USMODERNATX, INC.MOD20213
Write-up: 2-3 days ago, his arm started swelling a little bit/later on, the swelling started, It became two sizes bigger than the other arm; Arm hurted,still hurting, still hurting; couldn''t lift his arm,couldn''t raise his arm up,couldn''t lift anything heavy with that arm; Couldn''t lift anything heavy with that arm; blood clot; This spontaneous case was reported by a consumer and describes the occurrence of THROMBOSIS (blood clot), VACCINATION SITE SWELLING (2-3 days ago, his arm started swelling a little bit/later on, the swelling started, It became two sizes bigger than the other arm) and PAIN IN EXTREMITY (Arm hurted,still hurting, still hurting) in an 18-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 051C21A and 022D21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 12-May-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 09-Jun-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. In September 2021, the patient experienced THROMBOSIS (blood clot) (seriousness criterion medically significant). On an unknown date, the patient experienced VACCINATION SITE SWELLING (2-3 days ago, his arm started swelling a little bit/later on, the swelling started, It became two sizes bigger than the other arm) (seriousness criterion medically significant), PAIN IN EXTREMITY (Arm hurted,still hurting, still hurting) (seriousness criterion medically significant), MOBILITY DECREASED (couldn''t lift his arm,couldn''t raise his arm up,couldn''t lift anything heavy with that arm) and MUSCULAR WEAKNESS (Couldn''t lift anything heavy with that arm). The patient was treated with RIVAROXABAN (XARELTO) for Adverse event, at an unspecified dose and frequency. At the time of the report, THROMBOSIS (blood clot), VACCINATION SITE SWELLING (2-3 days ago, his arm started swelling a little bit/later on, the swelling started, It became two sizes bigger than the other arm), PAIN IN EXTREMITY (Arm hurted,still hurting, still hurting), MOBILITY DECREASED (couldn''t lift his arm,couldn''t raise his arm up,couldn''t lift anything heavy with that arm) and MUSCULAR WEAKNESS (Couldn''t lift anything heavy with that arm) outcome was unknown. No relevant concomitant medication information provided. Patient visited hospital in month of September because of swelling. Company Comment: This case concerns an 18-year-old male patient with no relevant medical history, who experienced the unexpected event of Thrombosis. The event occurred approximately 4 months after receiving the second dose of mRNA-1273 (Moderna COVID-19 Vaccine). The rechallenge was not applicable since only information about the second dose was disclosed. The benefit-risk relationship of mRNA-1273 (Moderna COVID-19 Vaccine) is not affected by this report.; Sender''s Comments: This case concerns an 18-year-old male patient with no relevant medical history, who experienced the unexpected event of Thrombosis. The event occurred approximately 4 months after receiving the second dose of mRNA-1273 (Moderna COVID-19 Vaccine). The rechallenge was not applicable since only information about the second dose was disclosed. The benefit-risk relationship of mRNA-1273 (Moderna COVID-19 Vaccine) is not affected by this report. |
|
| VAERS ID: |
1850739 (history) |
| Form: |
Version 2.0 |
| Age: |
16.0 |
| Sex: |
Male |
| Location: |
New York |
| Vaccinated: | 2021-09-18 |
| Onset: | 2021-09-18 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-11-08 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 2 |
UN / SYR |
Administered by: Unknown Purchased by: ?
Symptoms: Anti-platelet factor 4 antibody positive,
Blood albumin decreased,
Brachiocephalic vein thrombosis,
C-reactive protein increased,
Chest pain,
Coronary artery dilatation,
Dizziness,
Echocardiogram abnormal,
Fatigue,
Immunoglobulin therapy,
Laboratory test normal,
Lymphadenopathy,
Multisystem inflammatory syndrome in children,
Nasal congestion,
Nausea,
Pericardial effusion,
Procalcitonin increased,
Pyrexia,
Respiratory viral panel,
Rhinorrhoea,
SARS-CoV-2 antibody test positive,
SARS-CoV-2 test negative,
Thrombocytopenia,
Ultrasound Doppler abnormal,
Venous thrombosis limb
SMQs:, Acute pancreatitis (broad), Haematopoietic thrombocytopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Toxic-septic shock conditions (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (broad), Sepsis (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow), COVID-19 (narrow), Noninfectious myocarditis/pericarditis (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? Yes, 6 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Exam/Studies: +cervical adenopathy, echo + small pericardial effusion, mild dilation of the LM and LAD coronary artery, mild thrombocytopenia, low albumin, elevated CRP/Procalcitonin, negative RVP. COVID PCR negative (6/24/21, 9/24/21)+COVID serology--ID/Rheum initiated IV steroid and IVIGx1 for tx of "atypical MIS-C"; LUE occlusive thrombus within cephalic vein via U/S--tx Apixaban, VITT-HIT antibody screening was positive
CDC Split Type:
Write-up: 16 y/o male healthy p/w 5 days fever (Temp max 104), +nausea (no vomiting/diarrhea); + nasal congestion/rhinorrhea; +dizziness/fatigue, +intermittent chest pain, sx started the day after getting the 2nd Pfizer COVID vaccine; traveled in June; no known history of COVID infection/prior hospitalization; no known sick contacts. |
|
| VAERS ID: |
1854668 (history) |
| Form: |
Version 2.0 |
| Age: |
16.0 |
| Sex: |
Female |
| Location: |
Wisconsin |
| Vaccinated: | 2021-09-07 |
| Onset: | 2021-09-01 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-11-09 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
301308A / 2 |
LA / SYR |
Administered by: Private Purchased by: ?
Symptoms: Death,
Fatigue,
Myalgia,
Thrombosis
SMQs:, Rhabdomyolysis/myopathy (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-09-10
Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: omeprazole gabapentin celecoxib nivolumab was last given on 9/03/2021
Current Illness: Squamous cell lung cancer, Hx of radiation therapy, on antineoplastic chemotherapy, Esophagitis due to radiation,
Preexisting Conditions: Recurrent respiratory papillomatosis, Tracheal papillomatosis
Allergies: Pineapple
Diagnostic Lab Data: There was no autopsy ordered
CDC Split Type:
Write-up: Was very tired and had sore muscles on September 09. Found September 10, 5:25 am dead. There were excessive amounts of blood along with large blood clots that appear to have come vaginally. |
|
| VAERS ID: |
1963011 (history) |
| Form: |
Version 2.0 |
| Age: |
16.0 |
| Sex: |
Male |
| Location: |
Pennsylvania |
| Vaccinated: | 2021-08-24 |
| Onset: | 2021-10-31 |
| Days after vaccination: | 68 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-11-10 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
FD8448 / 2 |
LA / IM |
Administered by: Public Purchased by: ?
Symptoms: Deep vein thrombosis,
Fibrin D dimer increased,
Ultrasound Doppler abnormal
SMQs:, Haemorrhage laboratory terms (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: DM Type 1
Allergies:
Diagnostic Lab Data: 11/01/2021 had ultrasound at hospital. D dimer quantitative on 11/1/2021 result greater than 20.00
CDC Split Type:
Write-up: Patient experienced blood clot on right calf. Blood clot located for DVT from femoral down to ankle. Unknown if related to vaccine, diagnosed 11/1/2021. |
|
| VAERS ID: |
2036067 (history) |
| Form: |
Version 2.0 |
| Age: |
19.0 |
| Sex: |
Female |
| Location: |
Arizona |
| Vaccinated: | 2021-05-20 |
| Onset: | 2021-12-31 |
| Days after vaccination: | 225 |
| Submitted: |
0000-00-00 |
| Entered: |
2022-01-14 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
- / UNK |
- / - |
Administered by: Private Purchased by: ?
Symptoms: Cerebral venous sinus thrombosis,
Computerised tomogram head abnormal,
Magnetic resonance imaging
SMQs:, Embolic and thrombotic events, venous (narrow), Central nervous system vascular disorders, not specified as haemorrhagic or ischaemic (narrow)
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? Yes, 9 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Fluoxetine SPIRACTIN Cryselle Fabior Foam Clindamycin
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: CT scan Cerebral venous sinus thrombosis MRI
CDC Split Type:
Write-up: Blood clots in the brain sinus veins |
|
| VAERS ID: |
2055701 (history) |
| Form: |
Version 2.0 |
| Age: |
15.0 |
| Sex: |
Male |
| Location: |
Puerto Rico |
| Vaccinated: | 2021-08-11 |
| Onset: | 2021-10-20 |
| Days after vaccination: | 70 |
| Submitted: |
0000-00-00 |
| Entered: |
2022-01-21 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
FC3181 / 1 |
LA / SYR |
Administered by: Public Purchased by: ?
Symptoms: Headache,
Magnetic resonance imaging head abnormal,
Thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (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: Fever with 2 years old vaccine
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: So far none
Diagnostic Lab Data: Brain MRI 01/20/22 Thrombosis 01/20/22
CDC Split Type:
Write-up: It gives him constant headache at first. Now the headaches remain frequent. |
|
| VAERS ID: |
2104972 (history) |
| Form: |
Version 2.0 |
| Age: |
19.0 |
| Sex: |
Female |
| Location: |
Virginia |
| Vaccinated: | 2021-03-04 |
| Onset: | 2021-05-16 |
| Days after vaccination: | 73 |
| Submitted: |
0000-00-00 |
| Entered: |
2022-02-11 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
- / UNK |
- / - |
Administered by: Unknown Purchased by: ?
Symptoms: Pulmonary thrombosis
SMQs:, Embolic and thrombotic events, venous (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Abilify, Wellbutrin, trazodone, hydroxyzine, prazosin
Current Illness:
Preexisting Conditions:
Allergies: Penicillins and latex
Diagnostic Lab Data:
CDC Split Type:
Write-up: Blood clot in lung |
|
| VAERS ID: |
2161826 (history) |
| Form: |
Version 2.0 |
| Age: |
15.0 |
| Sex: |
Male |
| Location: |
Georgia |
| Vaccinated: | 2021-07-03 |
| Onset: | 2021-07-05 |
| Days after vaccination: | 2 |
| Submitted: |
0000-00-00 |
| Entered: |
2022-03-05 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EW0198 / 1 |
RA / - |
Administered by: Pharmacy Purchased by: ?
Symptoms: Peripheral swelling,
Thrombosis
SMQs:, Cardiac failure (broad), Angioedema (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 7 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None, Comment: known allergies: No other medical history: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202200334924
Write-up: blood clots in both legs; swelling in both legs; This is a spontaneous report received from contactable reporter(s) (Consumer or other non HCP). The reporter is the parent. A 15 year-old male patient received bnt162b2 (BNT162B2), administered in arm right, administration date 03Jul2021 14:00 (Lot number: EW0198) at the age of 15 years as dose 1, single for covid-19 immunisation. The patient had no relevant medical history. There were no concomitant medications. The following information was reported: THROMBOSIS (caused and prolonged hospitalization, medically significant, life threatening) with onset 05Jul2021 13:00, outcome "recovered with sequelae", described as "blood clots in both legs"; PERIPHERAL SWELLING (hospitalization, life threatening) with onset 05Jul2021 13:00, outcome "recovered with sequelae", described as "swelling in both legs". The patient was hospitalized and prolonged hospitalization for thrombosis (hospitalization duration: 7 day(s)); for peripheral swelling (hospitalization duration: 7 day(s)). The events "blood clots in both legs" and "swelling in both legs" were evaluated at the physician office visit and emergency room visit. Therapeutic measures were taken as a result of thrombosis, peripheral swelling. Clinical course: Patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. No List of any other medications the patient received within 2 weeks of vaccination. Prior to vaccination, the patient was not diagnosed with COVID-19 and not tested for COVID-19 since vaccination. Once properly diagnosed after swelling in both legs had to undergo surgery to remove blood clots in both legs just in time before clots moved to his heart or brain. Surgery to rmove blood clots. The patient had no known allergy. |
|
| VAERS ID: |
2176886 (history) |
| Form: |
Version 2.0 |
| Age: |
15.0 |
| Sex: |
Male |
| Location: |
Georgia |
| Vaccinated: | 2021-07-24 |
| Onset: | 2021-07-26 |
| Days after vaccination: | 2 |
| Submitted: |
0000-00-00 |
| Entered: |
2022-03-12 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EW0198 / 2 |
RA / - |
Administered by: Pharmacy Purchased by: ?
Symptoms: Deep vein thrombosis,
Thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 7 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Allergy to nuts
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202200322010
Write-up: This is a spontaneous report received from contactable reporter(s) (Consumer or other non HCP). The reporter is the patient. A 15 year-old male patient received bnt162b2 (BNT162B2), administered in arm right, administration date 24Jul2021 (Lot number: EW0198) at the age of 15 years as dose 2, single for Covid-19 immunisation. Relevant medical history included: "Known allergies: Peanuts" (unspecified if ongoing). There were no concomitant medications. Vaccination history included: Bnt162b2 (Dose Number: 1, Batch/Lot No: EW0198, Location of injection: Arm Left), administration date: 03Jul2021, when the patient was 15 years old, for COVID-19 immunization, reactions: "blood clots in both legs", "swelling in both legs". The following information was reported: THROMBOSIS (caused and prolonged hospitalization, life threatening) with onset 26Jul2021 12:00, outcome "recovered with sequelae", described as "Blood clots in both legs"; DEEP VEIN THROMBOSIS (caused and prolonged hospitalization, life threatening) with onset 26Jul2021 12:00, outcome "recovered with sequelae", described as "Deep vein thrombosis". The patient was hospitalized and prolonged hospitalization for thrombosis, deep vein thrombosis (hospitalization duration: 7 day(s)). The events "blood clots in both legs" and "deep vein thrombosis" were evaluated at the physician office visit and emergency room visit. Therapeutic measures were taken as a result of thrombosis, deep vein thrombosis. |
|
| VAERS ID: |
2194914 (history) |
| Form: |
Version 2.0 |
| Age: |
18.0 |
| Sex: |
Female |
| Location: |
Texas |
| Vaccinated: | 2021-01-08 |
| Onset: | 2022-03-21 |
| Days after vaccination: | 437 |
| Submitted: |
0000-00-00 |
| Entered: |
2022-03-23 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
007M20A / 3 |
RA / IM |
Administered by: Other Purchased by: ?
Symptoms: Pain in extremity,
Platelet count decreased,
Tachycardia,
Thrombosis,
Ultrasound Doppler abnormal,
Vomiting
SMQs:, Acute pancreatitis (broad), Haematopoietic thrombocytopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), 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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 3/21/22 venous Doppler showed DVT on right leg, extending from mid right femoral vein through the posterior tibial and peroneal veins. Platelet count was a little low at 113 K/mm3 on 3/20/22.
CDC Split Type:
Write-up: COVID vaccination history: 1st dose 1/8/21, 2nd dose 2/8/21, booster 12/2/21. Patient was admitted to local hospital 3/16/22 for intractable vomiting and discharged back to FACILITY 3/20/22. Workup revealed no clear etiology for vomiting. After return, tachycardia was noted and resident reported right calf pain - PCP ordered LE venous dopplers for further evaluation of calf pain. PCP''s 3/21/22 note states venous Doppler showed DVT on right leg, extending from mid right femoral vein through the posterior tibial and peroneal veins. Patient admitted to hospital for initiation of warfarin therapy until stable. |
|
| VAERS ID: |
2196300 (history) |
| Form: |
Version 2.0 |
| Age: |
14.0 |
| Sex: |
Male |
| Location: |
New Jersey |
| Vaccinated: | 2021-07-20 |
| Onset: | 2021-08-22 |
| Days after vaccination: | 33 |
| Submitted: |
0000-00-00 |
| Entered: |
2022-03-24 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 2 |
LA / SYR |
Administered by: Public Purchased by: ?
Symptoms: Blood test,
Chest X-ray,
Computerised tomogram,
Cyanosis,
Deep vein thrombosis,
Echocardiogram,
Livedo reticularis,
Scan with contrast,
Ultrasound Doppler,
Ultrasound abdomen,
Ultrasound pelvis,
Ultrasound scan abnormal
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Hypotonic-hyporesponsive episode (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: n/a
Current Illness: n/a
Preexisting Conditions: innocent heart murmur
Allergies: n/a
Diagnostic Lab Data: CAT scan with contrast 03/24/2022 chest xrays 12/7/2021 CONGENITAL TRANSTHORACIC ECHO (TTE) 10/21/2021 US Pelvis Transabdominal 12/6/2021 US LOWER EXTREMITY DVT 12/6/2021 2 vascular ultrasounds lower extremities 2/18/2022 bloodwork 12/29/2021 bloodwork 3/11/2022 bloodwork 11/12/2021
CDC Split Type:
Write-up: undiagnosed chronic health condition - when standing legs turn blue and mottled from the mid thigh down |
|
| VAERS ID: |
2284986 (history) |
| Form: |
Version 2.0 |
| Age: |
19.0 |
| Sex: |
Female |
| Location: |
Alabama |
| Vaccinated: | 2021-05-10 |
| Onset: | 2021-06-01 |
| Days after vaccination: | 22 |
| Submitted: |
0000-00-00 |
| Entered: |
2022-05-19 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN |
1805022 / 1 |
RA / SYR |
Administered by: Pharmacy Purchased by: ?
Symptoms: Blood test,
Compartment pressure test,
Compartment syndrome,
Electrocardiogram,
Limb operation,
Nerve conduction studies,
Peripheral swelling,
Rhabdomyolysis,
Thrombosis,
Ultrasound Doppler abnormal,
Urine analysis
SMQs:, Rhabdomyolysis/myopathy (narrow), Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Cryselle 28
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Bloodwork taken 6/7/2021, 6/8/2021, 6/23/2021, 8/18/2021, 9/22/2021, 10/5/2021, 11/11/2021, 12/9/2021; Urinalysis collected 9/22/2021; MRI 10/5/2021; Nerve assessment 10/18/2021; Ultrasound 10/25/2021; EKG 11/5/2021; Compartment testing 12/16/2021 right arm and 5/12/2022 left arm.
CDC Split Type:
Write-up: Rhabdomyolysis 6/1/2021. Hospitalization 6/8/2021. Persistent swelling of both arms following release from Rhabdomyolysis. Ultrasound noted signs of prior blood clots in arms 10/25/2021. Compartment surgery on right forearm 5/16/2022. |
|
| VAERS ID: |
2371470 (history) |
| Form: |
Version 2.0 |
| Age: |
16.0 |
| Sex: |
Male |
| Location: |
Pennsylvania |
| Vaccinated: | 2021-06-03 |
| Onset: | 2021-07-28 |
| Days after vaccination: | 55 |
| Submitted: |
0000-00-00 |
| Entered: |
2022-07-16 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 2 |
LA / - |
Administered by: Unknown Purchased by: ?
Symptoms: Blood test,
Cardiac dysfunction,
Pulmonary embolism,
Pulmonary thrombosis,
SARS-CoV-2 test
SMQs:, Cardiac failure (broad), Embolic and thrombotic events, venous (narrow), Cardiomyopathy (broad), COVID-19 (broad)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210803; Test Name: Blood test; Result Unstructured Data: Test Result:Negative; Test Date: 20210803; Test Name: Nasal Swab; Result Unstructured Data: Test Result:Negative
CDC Split Type: USPFIZER INC202200943869
Write-up: Lungs filled with blood clots; Lungs filled with blood clots; heart was strained trying to pump blood through the clots; This is a spontaneous report received from contactable consumer. The reporter is the patient. A 16-year-old male patient received BNT162b2 (BNT162B2), on 03Jun2021 as dose 2, single (Batch/Lot number: unknown) at the age of 16 years, in left arm for covid-19 immunisation. The patient''s relevant medical history and concomitant medications were not reported. Vaccination history included: Bnt162b2 (Dose 1, lot number: unknown at this time in the left arm), for COVID-19 Immunization. The following information was reported: PULMONARY EMBOLISM (hospitalization, disability, medically significant, life threatening), PULMONARY THROMBOSIS (hospitalization, disability, medically significant, life threatening) all with onset 28Jul2021, outcome "not recovered" and all described as "Lungs filled with blood clots"; MYOCARDIAL INJURY (hospitalization, disability, medically significant, life threatening) with onset 28Jul2021, outcome "not recovered", described as "heart was strained trying to pump blood through the clots". The patient was hospitalized for pulmonary embolism, myocardial injury, pulmonary thrombosis (hospitalization duration: 6 day(s)). The events "lungs filled with blood clots" and "heart was strained trying to pump blood through the clots" required physician office visit and emergency room visit. The patient underwent the following laboratory tests and procedures: Blood test: (03Aug2021) Negative; SARS-CoV-2 test: (03Aug2021) Negative. Therapeutic measures were taken as a result of pulmonary embolism, myocardial injury, pulmonary thrombosis. Additional information: It was reported that the patient lungs filled with blood clots and heart was strained trying to pump blood through the clots. Still having problems. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine and did not received any other medications the patient received within 2 weeks of vaccination. The patient was admitted to intensive care and was given blood thinners. The patient was not diagnosed with COVID-19 prior to vaccination. Since the vaccination, the patient been tested for COVID 19. The information on the batch/lot number for BNT162b2 has been requested and will be submitted if and when received. |
|
| VAERS ID: |
2407014 (history) |
| Form: |
Version 2.0 |
| Age: |
18.0 |
| Sex: |
Female |
| Location: |
Unknown |
| Vaccinated: | 2021-04-01 |
| Onset: | 2021-05-01 |
| Days after vaccination: | 30 |
| Submitted: |
0000-00-00 |
| Entered: |
2022-08-10 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 2 |
- / OT |
Administered by: Unknown Purchased by: ?
Symptoms: Cerebral thrombosis,
Diabetes mellitus,
Thrombosis,
Trisomy 21
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Ischaemic central nervous system vascular conditions (narrow), Congenital, familial and genetic disorders (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Immune-mediated/autoimmune disorders (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HUMIRA
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INCPV20220003863
Write-up: Non-Serious Down Syndrome; diabetes; 14 Inches Long Blood Clot in the Femoral Brain; Blood Clot; This is a solicited report received from contactable reporter(s) (Consumer or other non HCP). The reporter is the patient. Other Case identifier(s): 2K-163-4265157-00. A 19-year-old female patient received BNT162b2 (BNT162B2), on 01Apr2021 as dose 2, single (Batch/Lot number: unknown) at the age of 18 years intramuscular for covid-19 immunisation; adalimumab (HUMIRA), (Batch/Lot number: unknown) at citrate free, subcutaneous for rheumatoid arthritis. The patient''s relevant medical history and concomitant medications were not reported. Vaccination history included: BNT162b2 (DOSE: 1, Route of Admin: Intramuscular), administration date: 09Mar2021, when the patient was 18-year-old, for COVID-19 Immunization. The following information was reported: THROMBOSIS (disability) with onset May2021, outcome "recovered", described as "Blood Clot"; CEREBRAL THROMBOSIS (disability) with onset 29Jun2021, outcome "recovering", described as "14 Inches Long Blood Clot in the Femoral Brain"; TRISOMY 21 (disability), outcome "unknown", described as "Non-Serious Down Syndrome"; DIABETES MELLITUS (disability), outcome "recovering", described as "diabetes". The action taken for adalimumab was unknown. Additional information: It was unknown if patient was enrolled in a COVID-19 Vaccine Trial. Causality for Humira (Adalimumab) The reporter''s causality for the event(s) of disabled, 14 inches long blood clot in the femoral brain, blood clot, down syndrome, diabetes was not provided. Company''s opinion is that there is no reasonable possibility that the events of disabled, 14 inches long blood clot in the femoral brain, down syndrome, diabetes are related to Humira (Adalimumab). Company''s opinion is that the event of Blood Clot is not assessable. Causality for vaccine Clot blood (Thrombosis) Causality as per reporter (Drug/Vaccine): Possible. The reporter''s assessment of the causal relationship of "14 inches long blood clot in the femoral brain", "non-serious down syndrome" and "diabetes" with the suspect product(s) BNT162b2 was not provided at the time of this report. Since no determination has been received, the case is managed based on the company causality assessment. The reporter considered "blood clot" related to BNT162b2. The information on the batch/lot number for BNT162b2 has been requested and will be submitted if and when received.; Sender''s Comments: Based on the available clinical data, reported events were most likely from an intercurrent medical condition considered unrelated to vaccination with BNT162B2. This case will be re-evaluated upon receipt of additional information. |
|
| VAERS ID: |
2449618 (history) |
| Form: |
Version 2.0 |
| Age: |
19.0 |
| Sex: |
Female |
| Location: |
Alabama |
| Vaccinated: | 2021-05-10 |
| Onset: | 2021-06-01 |
| Days after vaccination: | 22 |
| Submitted: |
0000-00-00 |
| Entered: |
2022-09-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN |
1805022 / 1 |
- / - |
Administered by: Pharmacy Purchased by: ?
Symptoms: Blood test,
Compartment pressure test,
Compartment syndrome,
Electrocardiogram,
Limb operation,
Magnetic resonance imaging,
Nerve conduction studies,
Peripheral swelling,
Rhabdomyolysis,
Thrombosis,
Ultrasound Doppler,
Ultrasound Doppler abnormal,
Urine analysis
SMQs:, Rhabdomyolysis/myopathy (narrow), Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: CRYSELLE
Current Illness:
Preexisting Conditions: Comments: The patient had no allergies to medications, food, or other products. No other illnesses at the time of vaccination and up to one month prior. No chronic or long standing conditions. The patient did not had an adverse event following any previous vaccine. The patient was not pregnant at the time of vaccination.
Allergies:
Diagnostic Lab Data: Test Date: 20210607; Test Name: BLOOD TEST; Result Unstructured Data: Not reported; Test Date: 20210608; Test Name: BLOOD TEST; Result Unstructured Data: Not reported; Test Date: 20210623; Test Name: BLOOD TEST; Result Unstructured Data: Not reported; Test Date: 20210818; Test Name: BLOOD TEST; Result Unstructured Data: Not reported; Test Date: 20210922; Test Name: BLOOD TEST; Result Unstructured Data: Not reported; Test Date: 20210922; Test Name: URINE ANALYSIS; Result Unstructured Data: Not reported; Test Date: 20211005; Test Name: BLOOD TEST; Result Unstructured Data: Not reported; Test Date: 20211005; Test Name: MRI; Result Unstructured Data: Not reported; Test Date: 20211018; Test Name: NERVE CONDUCTION STUDIES; Result Unstructured Data: Not reported; Test Date: 20211025; Test Name: ULTRASOUND DOPPLER; Result Unstructured Data: Abnormal; Comments: signs of prior blood clots in arms; Test Date: 20211105; Test Name: EKG; Result Unstructured Data: Not reported; Test Date: 20211111; Test Name: BLOOD TEST; Result Unstructured Data: Not reported; Test Date: 20211209; Test Name: BLOOD TEST; Result Unstructured Data: Not reported; Test Date: 20211216; Test Name: COMPARTMENT PRESSURE TEST RIGHT ARM; Result Unstructured Data: Not reported; Test Date: 20220512; Test Name: COMPARTMENT PRESSURE TEST LEFT ARM; Result Unstructured Data: Not reported
CDC Split Type: USJNJFOC20220560207
Write-up: LIMB OPERATION; COMPARTMENT PRESSURE TEST; ELECTROCARDIOGRAM; ULTRASOUND DOPPLER ABNORMAL; THROMBOSIS; NERVE CONDUCTION STUDIES; URINE ANALYSIS; BLOOD TEST; COMPARTMENT SYNDROME; PERIPHERAL SWELLING; RHABDOMYOLYSIS; This spontaneous report received from a health care professional by a Regulatory Authority concerned a 19 year old female. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included: The patient had no allergies to medications, food, or other products. No other illnesses at the time of vaccination and up to one month prior. No chronic or long standing conditions. The patient did not had an adverse event following any previous vaccine. The patient was not pregnant at the time of vaccination. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1805022 expiry: unknown) dose was not reported, administered 1 in total to the right arm on 10-MAY-2021 at 11:00 for an unspecified indication. Age at time of vaccination 19 years old. Concomitant medications included (Cryselle 28) ethinylestradiol/norgestrel. On 01-JUN-2021 at 08:00, the patient experienced compartment syndrome, and rhabdomyolysis. Patient was having persistent swelling of both arms (peripheral swelling) following release from rhabdomyolysis. On 07-JUN-2021 and 08-JUN-2021, blood work (blood test) was taken, result was not reported. Patient was hospitalized on 08-JUN-2021. The duration of hospitalization was 1 day. On 23-JUN-2021 and 18-AUG-2021, laboratory data included: Blood test (NR: not provided) Not reported. On 22-SEP-2021, Laboratory data included: Blood test and urine analysis (NR: not provided) Not reported. On 05-OCT-2021, Laboratory data included: Blood test and MRI (Magnetic resonance imaging) (NR: not provided) Not reported. On 18-OCT-2021, Laboratory data included nerve conduction studies (NR: not provided) Not reported. On 25-OCT-2021, the patient experienced thrombosis, and ultrasound Doppler test was abnormal with signs of prior blood clots in arms. On 05-NOV-2021, laboratory data included: EKG (electrocardiogram) (NR: not provided) Not reported. On 11-NOV-2021, Laboratory data included: Blood test (NR: not provided) Not reported. On 09-DEC-2021, Laboratory data included: Blood test (NR: not provided) Not reported. On 16-DEC-2021, the patient experienced compartment pressure test on right arm. Laboratory data included: Compartment pressure test (NR: not provided) Not reported. On 12-MAY-2022, Laboratory data included: Compartment pressure test on left arm (NR: not provided) Not reported. On 16-MAY-2022, the patient had limb operation (Compartment surgery on right forearm). The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from blood test, compartment pressure test, compartment syndrome, electrocardiogram, limb operation, nerve conduction studies, peripheral swelling, rhabdomyolysis, thrombosis, ultrasound doppler abnormal, and urine analysis. This report was serious (Hospitalization Caused / Prolonged, and Disability Or Permanent Damage). Additional information was received from health care professional by a Regulatory Authority VAERS on 06-SEP-2022. The following information was updated and incorporated into the case narrative: patient''s race, ethnic origin and pre-existing medical condition, vaccination and event time was added.; Sender''s Comments: V1: This follow up adds information about patient''s race, ethnic origin and pre-existing medical condition, vaccination and event time. MAC reassessed. 20220560207-COVID-19 VACCINE AD26.COV2.S-rhabdomyolysis, compartment syndrome, electrocardiogram, limb operation, nerve conduction studies, peripheral swelling, compartment pressure test, blood test, and urine analysis. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s). Therefore, this event(s) is considered unassessable. 20220560207-COVID-19 VACCINE AD26.COV2.S-thrombosis, ultrasound doppler abnormal . The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and is scientifically plausible. There are other factors more likely to be associated with the event(s) than the drug. Specifically: CONMEDS-OTHER SUSPECT DRUGS. Therefore, this event(s) is considered not related. (patient''s concomitant medication- (Cryselle 28) ethinylestradiol/norgestrel is considered as confounding factor) |
|
| VAERS ID: |
2561134 (history) |
| Form: |
Version 2.0 |
| Age: |
18.0 |
| Sex: |
Male |
| Location: |
Connecticut |
| Vaccinated: | 2021-04-03 |
| Onset: | 2022-12-12 |
| Days after vaccination: | 618 |
| Submitted: |
0000-00-00 |
| Entered: |
2023-01-16 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN |
042A21A / 1 |
LA / SYR |
Administered by: Public Purchased by: ?
Symptoms: Anticoagulant therapy,
Blood test,
Computerised tomogram thorax abnormal,
Fibrin D dimer,
Pelvic venous thrombosis,
Pulmonary embolism,
Scan abdomen abnormal
SMQs:, Retroperitoneal fibrosis (broad), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (broad), Cardiomyopathy (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? Yes, 3 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: D dimer, blood work, CT chest scan, Abdomen scan,
CDC Split Type:
Write-up: 12/12/22 diagnosed with unprovoked Pulmonary Embolism and Iliac DVT. survived. On blood thinners for life. |
|
| VAERS ID: |
2575964 (history) |
| Form: |
Version 2.0 |
| Age: |
19.0 |
| Sex: |
Male |
| Location: |
New Mexico |
| Vaccinated: | 2021-05-14 |
| Onset: | 2021-09-29 |
| Days after vaccination: | 138 |
| Submitted: |
0000-00-00 |
| Entered: |
2023-02-05 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
037C21A / 1 |
LA / IM |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
047C21A / 2 |
LA / IM |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
062H21A / 3 |
LA / IM |
Administered by: Public Purchased by: ?
Symptoms: Arthralgia,
Blood test normal,
Carpal tunnel syndrome,
Compartment syndrome,
Fibrin D dimer normal,
Heart rate irregular,
Hypotension,
Immunisation reaction,
Laboratory test,
Magnetic resonance imaging normal,
Malaise,
Nausea,
Paget-Schroetter syndrome,
Pain,
Pain in extremity,
Peripheral swelling,
Rhabdomyolysis,
Subclavian vein thrombosis,
Thrombosis
SMQs:, Rhabdomyolysis/myopathy (narrow), Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiac arrhythmia terms, nonspecific (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Dehydration (broad), Hypokalaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 20 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: several blood tests, MRI and other tests that ruled out arthritis, muscular breakdown, and all other diseases that caused his bilateral arm swelling, severe pain in both arms, wrists. No relief from multiple steroids, physiotherapy, etc. Compression test and recent MRI were all negative.
CDC Split Type:
Write-up: Patient Medical Update January 19, 2022 from May 14, 2021 May 14 2021 Moderna first vaccination Sore left arm for 3 days. No other issues. June 7, 2021 Moderna second vaccination Low blood pressure, nausea, pain for 3 days requiring two I.V.?s. Then 3 weeks sore arm. October 22, 2021 Left arm swelling, week. Severe pain, went to emergency room. Letter to Emergency Department ACUTE PROGRESSIVE SWELLING OF NONDOMINANT LEFT ARM ONE WEEK HISTORY OF PROGRESSIVE SWELLING OF LEFT ARM. NO HISTORY OF STRENESOUS ACTIVTY, INFECTION, AFEBRILE, OR TRAUMA TO THE LEFT ARM. IBUPROFEN 400 MG Q8H FOR ONE WEEK HAS NOT RELEIVED PAIN OR SWELLING. COLD COMPRESSES AND ELEVATION FOR ONE WEEK ALSO NOT EFFECTIVE. PAIN IS INCREASING OVER THE COURSE OF ONE WEEK. STARTED ASPIRIN Q4-6H OCT 22 LATE EVENING. EMERGENCY ROOM VISIT ON OCTOBER 22 RESULTED IN NO DIAGNOSIS WITH ONLY IBUPROFEN THERAPY. REGULAR PEDIATRIC CARE. DOG BITE TO CRANIUM AT 6 YEARS OF AGE. TWO CONCUSSIONS IN ADOLESCENCE TREATED BY DOCTOR, CONCUSSION AND NEUROLOGIST SPECIALIST IMMUNIZATIONS UP TO DATE. MODERNA MAY THEN JUNE 2021. 1) PAGET SCHROETTER SYNDROME AXIAL SUBCLAVIAN VEIN THROMBOSIS REQUIRING IMMEDIATE DIAGNOSIS AND THROMBOLYTIC THERAPY. MOST COMMON IN ACTIVE YOUNG MEN. 2) CARPELL TUNNEL SYNDROME 3) RHABDOMYOLYSIS 4) MALIGNANCY November early Swelling went down, no pain. Still sore left hand & arm when in use. December 24, 2021 Moderna 3rd vaccination Sick and sore arm for a week. January early Left and right arm both hurt, circular wrist pain, severe pain on tip of right index finger, minor in left. Pain in right arm started first time in right arm. Exam by doctor. Consults with Doctor for irregular heartbeat, clotting, and ordered an echocardiogram. Hand Surgeon, whom suspects either a rare vaccination reaction, compartment syndrome with arm/hand nerves, or plain over usage. Ordered bilateral MRI?s. Jan 6 Labs .48 D-Dimer mg/L, normal .19 for age. Normal 0-49. Jan 19th No relief to date from rest. Started two days ago 250mg Naproxen q6h & 1% Diclofenac Sodium Topical. |
|
| VAERS ID: |
2593893 (history) |
| Form: |
Version 2.0 |
| Age: |
15.0 |
| Sex: |
Male |
| Location: |
Unknown |
| Vaccinated: | 2021-08-08 |
| Onset: | 2023-02-23 |
| Days after vaccination: | 564 |
| Submitted: |
0000-00-00 |
| Entered: |
2023-03-09 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 2 |
- / IM |
Administered by: Unknown Purchased by: ?
Symptoms: Anticoagulant therapy,
Deep vein thrombosis,
Intensive care,
Pain in extremity,
Thrombectomy
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Tendinopathies and ligament 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? Yes, 9 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Asthma
Allergies: Bees, Milk, Penicillin
Diagnostic Lab Data:
CDC Split Type:
Write-up: 5d LLE pain found to have unprovoked LLE DVT minimally responsive to anticoagulation, requiring prolonged ICU stay, thrombectomy, and ongoing anticoagulation. No anatomic variants found. Possible coagulopathy, requires further workup following resolution of acute thrombosis. Ongoing ICU stay at time of submission - family requested immediate report be filed. |
|
| VAERS ID: |
2665724 (history) |
| Form: |
Version 2.0 |
| Age: |
16.0 |
| Sex: |
Male |
| Location: |
Texas |
| Vaccinated: | 2021-05-24 |
| Onset: | 2021-09-12 |
| Days after vaccination: | 111 |
| Submitted: |
0000-00-00 |
| Entered: |
2023-08-03 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EW0178 / 2 |
UN / IM |
Administered by: Private Purchased by: ?
Symptoms: Deep vein thrombosis,
Ultrasound Doppler abnormal
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Cardiomyopathy (broad)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Discovered to be heterozygous for Factor V Leiden deficiency
Allergies: Tree nuts
Diagnostic Lab Data: 9/15/22. Ultrasound
CDC Split Type:
Write-up: Developed DVT right femoral, popliteal, calf veins, onset of symptoms 9/12/22, diagnosed 9/15/22 by ultrasound at a local hospital. |
|
| VAERS ID: |
1152868 (history) |
| Form: |
Version 2.0 |
| Age: |
16.0 |
| Sex: |
Male |
| Location: |
Foreign |
| Vaccinated: | 2021-02-17 |
| Onset: | 2021-02-24 |
| Days after vaccination: | 7 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-03-31 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
UNKNOWN / 2 |
LA / - |
Administered by: Other Purchased by: ?
Symptoms: Arterial thrombosis
SMQs:, Embolic and thrombotic events, arterial (narrow)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Smoker
Allergies:
Diagnostic Lab Data:
CDC Split Type: ILPFIZER INC2021329787
Write-up: Thrombosis with blockage of several arteries in the left hand; This is a spontaneous report from a contactable consumer. A 16-year-old male patient received second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, lot number and expiration date: unknown), via an unspecified route of administration, administered in left arm on 17Feb2021 as single dose for COVID-19 immunization. The patient''s was smoker. The patient''s concomitant medications were not reported. The patient previously took first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE) on 21Jan2021 for COVID-19 immunization. On 24Feb2021, the patient experienced thrombosis with blockage of several arteries in the left hand. The adverse event required hospitalization and surgical treatment. There is no background diseases. Other reasons which may have caused the thrombosis were denied. The patient also received Clexane as treatment. The outcome of the events was recovering. The patient was not diagnosed with COVID-19 prior to vaccination. The patient has not been tested for COVID-19 since the vaccination. The event resulted in visit in office or physician clinic or other health care provider, visit in emergency room or emergency center, hospitalization, life threatening condition (immediate damage to death as a results from the adverse event), disability or permanent damage. Information on the lot/batch number has been requested. |
|
