|
| VAERS ID: |
903094 (history) |
| Form: |
Version 2.0 |
| Age: |
38.0 |
| Sex: |
Female |
| Location: |
Wisconsin |
| Vaccinated: | 2020-12-16 |
| Onset: | 2020-12-16 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Chills,
Dizziness,
Fatigue,
Feeling cold,
Heart rate increased,
Hypertension,
Incoherent,
Tinnitus
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hypertension (narrow), Hearing impairment (narrow), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D3, C, Zinc
Current Illness: Had COVID in the beginning of 11/2020. (Tested on 11/03 results came on 4th - positive)
Preexisting Conditions: None
Allergies: Penicillin
Diagnostic Lab Data: None
CDC Split Type: VSafe
Write-up: 40 min after shot experienced dizziness, feeling like was going to pass out, not coherent, BP high, fast heart rate, light headed. Got chills, freezing cold, shivering, and later in the day my ears were ringing. Extremely fatigued. |
|
| VAERS ID: |
903169 (history) |
| Form: |
Version 2.0 |
| Age: |
49.0 |
| Sex: |
Female |
| Location: |
Wisconsin |
| Vaccinated: | 2020-12-17 |
| Onset: | 2020-12-17 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EK5730 / UNK |
- / - |
Administered by: Private Purchased by: ?
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: unknown
Preexisting Conditions:
Allergies: Walnuts, decadron
Diagnostic Lab Data:
CDC Split Type:
Write-up: Light headed, felt faint. Vitals remained stable. Did need to lay down for approximately 30 min. then sent to ED for evaluation |
|
| VAERS ID: |
903217 (history) |
| Form: |
Version 2.0 |
| Age: |
30.0 |
| Sex: |
Female |
| Location: |
Wisconsin |
| Vaccinated: | 2020-12-16 |
| Onset: | 2020-12-16 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EK5730 / UNK |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Dizziness,
Headache,
Increased upper airway secretion
SMQs:, Anticholinergic syndrome (broad), Vestibular 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Spironolactone 50 mg bid, vitamin d 2000iu
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa
Diagnostic Lab Data:
CDC Split Type:
Write-up: COVID vaccine administered to patient. She began to have lightheadedness and dizziness. She disclosed she had not yet eaten for the day, except for a glass of milk. Writer brought her to an exam table and had her lay down. After 5-10 minutes, she was given a banana and two small apple juice boxes. She then laid back down. After another 5 minutes, she complained of headache and slight phlegm development in her throat. Dr. was called to evaluate- after an assessment, she asked for a BP. Writer completed the vitals and found her BP was 113/77. 5 more minutes passed. Dr. advised that since her situation was not improving and headache and phlegm appeared to be getting worse, patient should receive epi and go to the hospital. Writer administered 0.3mg/0.3mL of epi and drove patient to the Emergency Department of Hospital. She was there for about two hours before being discharged. Symptoms largely resolved by the evening. |
|
| VAERS ID: |
903583 (history) |
| Form: |
Version 2.0 |
| Age: |
42.0 |
| Sex: |
Female |
| Location: |
Wisconsin |
| Vaccinated: | 2020-12-16 |
| Onset: | 2020-12-16 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-18 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Fatigue,
Headache,
Insomnia,
Nasal congestion,
Nausea,
SARS-CoV-2 test positive
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? No
Previous Vaccinations:
Other Medications: IUD ..
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type: vsafe
Write-up: Round 5:30 P.m. I started becoming nauseas, I had a terrible headache , OTC Ibuprofen did not help, nasal congestion ,, Only slept 2 Hours Wednesday night.. the next day 7am stayed in bed all day , headaches, congestion was worse. Could not sleep. Feeling better today but I am super tired 10/02/2020 Was tested for COVID-19 . The test was confirmed positive the next day. |
|
| VAERS ID: |
903611 (history) |
| Form: |
Version 2.0 |
| Age: |
59.0 |
| Sex: |
Female |
| Location: |
Wisconsin |
| Vaccinated: | 2020-12-17 |
| Onset: | 2020-12-17 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-18 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EH9899 / 1 |
RA / IM |
Administered by: Work Purchased by: ?
Symptoms: Headache,
Increased appetite
SMQs:, Hyperglycaemia/new onset diabetes mellitus (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: Influenza vaccine
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Headache, increased heart rate (115) for approx 30 min. |
|
| VAERS ID: |
903749 (history) |
| Form: |
Version 2.0 |
| Age: |
47.0 |
| Sex: |
Female |
| Location: |
Wisconsin |
| Vaccinated: | 2020-12-18 |
| Onset: | 2020-12-18 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-18 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EK5730 / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Dizziness,
Posture abnormal
SMQs:, Anticholinergic syndrome (broad), Dystonia (broad), Vestibular disorders (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data: n/a
CDC Split Type:
Write-up: Patient became light headed and dizzy, patient stated often reacts this way after injections. Minimal po intake prior to immunization. Patient laid flat on the floor, drank 10 ounces of water, 4 oz. Orange juice. BP went from 94/50 to 108/62 ten minutes after first measure. Prior to leaving BP was 110/64, pulse 64 and patient reported no symptoms. Patient refused transfer to ED and felt fine prior to leaving after 30 minutes of observation. She left in care of two co-worker RNs feeling asymptomatic and ambulating independently. |
|
| VAERS ID: |
903922 (history) |
| Form: |
Version 2.0 |
| Age: |
30.0 |
| Sex: |
Female |
| Location: |
Wisconsin |
| Vaccinated: | 2020-12-18 |
| Onset: | 2020-12-18 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-18 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EJ1685 / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Dizziness,
Dysphagia,
Dysphonia,
Dyspnoea,
Pruritus,
Rash,
Throat tightness,
Urticaria,
Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Allegra, Singulair, Pepcid, Vit D
Current Illness: None
Preexisting Conditions: Migraines, allergic rhinitis
Allergies: Erenumab-aooe, Prednisone, Bees
Diagnostic Lab Data:
CDC Split Type:
Write-up: Patient complaint of rash,hives,difficulty breathing and swallowing, wheezing, throat tightness, hoarseness, itching and feeling light headed less than 10 minutes after receiving the vaccine. Patient received Benadryl 50mg IVP, Pepcid 20mg IVP, 0.3mg epi IM. EMS arrived and transported patient to ED. In ED, patient received second dose of 0.3mg epi IM. Patient monitored in ED for approximately 4 hours. Epi drip started and plan to admit patient for observation. |
|
| VAERS ID: |
904241 (history) |
| Form: |
Version 2.0 |
| Age: |
40.0 |
| Sex: |
Male |
| Location: |
Wisconsin |
| Vaccinated: | 2020-12-16 |
| Onset: | 2020-12-18 |
| Days after vaccination: | 2 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-19 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
LA / IM |
Administered by: Unknown Purchased by: ?
Symptoms: Fatigue,
Rash morbilliform
SMQs:, Hypersensitivity (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: Valacyclovir Famotidine Flonase
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:
Write-up: Morbiliform rash on torso Tiredness |
|
| VAERS ID: |
904420 (history) |
| Form: |
Version 2.0 |
| Age: |
33.0 |
| Sex: |
Female |
| Location: |
Wisconsin |
| Vaccinated: | 2020-12-17 |
| Onset: | 2020-12-18 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-20 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EJ1685 / 1 |
LA / IM |
Administered by: Work Purchased by: ?
Symptoms: Arthralgia,
Fatigue,
Flushing,
Hyperhidrosis,
Injection site pain,
Pain,
Pain of skin,
Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lo-ogestrel, levothyroxine, cabergoline.
Current Illness: N/A
Preexisting Conditions: Hypothyroid and prolactinoma
Allergies: NKDA and no food allergies
Diagnostic Lab Data: N/A
CDC Split Type:
Write-up: Very painful to injection site that woke me up the night of 12/17 into 12/18. Became febrile at 100.5F oral Friday 12/18 with body aches, joint pain, extreme fatigue, skin hurt between 4-5pm. 600 mg ibuprofen helped, however became flushed and sweaty. Saturday 12/19 woke up feeling fine. Around 3pm, body aches started again with bilateral hip pain, extreme fatigue, sweating. Temp was 101.1F oral at 7:15pm. I took 500mg acetaminophen and 600mg ibuprofen. Today, again woke up feeling fine at 9am, felt asymptotic. On the way to work at 10am, became sweaty/fatigued/body aches again. At work, 10:45am temp was 99.6F oral. I took 500/600 of Tylenol and ibuprofen. |
|
| VAERS ID: |
904488 (history) |
| Form: |
Version 2.0 |
| Age: |
38.0 |
| Sex: |
Female |
| Location: |
Wisconsin |
| Vaccinated: | 2020-12-17 |
| Onset: | 2020-12-17 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-20 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EK5730 / 1 |
LA / IM |
Administered by: Work Purchased by: ?
Symptoms: Abdominal pain,
Angina pectoris,
Chest pain,
Condition aggravated,
Dyspnoea,
Injection site erythema,
Injection site pain,
Nausea,
Pruritus,
Rash,
Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Other ischaemic heart disease (narrow), Hypersensitivity (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ARIPIPRAVOLE 10 MG/DAILY; BUSPIRONE 30 MG 2XDAILY; ZYRTEC 10 MG 1DAILY; VILTIAZEM 360 MG 1XDAILY; DULOXETINE 40 MG 1XDAILY; LASIXS 40 MG 1XDAILY; GABAPENTIN 600 MG 2XDAILY; ISOSORBIDE-MONONITRATE 120 MG 2XDAILY ; LEVOTHYROXINE 50 MCG EVERY
Current Illness: BACK INJURY, PAIN MEDICATION (OXYCODONE) ANGINA PAIN; PRITZMETALS
Preexisting Conditions: PRITZMETALS BACK INJURY/ACUTE ACID REFLUX PCOS ENDOMETRIOSIS DEPRESSION ALLERGY INDUCED ASTHMA CORONARY VASCULAR DISFUNCTION
Allergies: PENICILLAN; CEPHALOSPORINS; VANCOMYCIN; CONTRAST DYE OMNISCAN
Diagnostic Lab Data: N/A
CDC Split Type: VSAFE
Write-up: 12/17/2020; 1158 am had injection. at 2pm, noticed trunk itching around waist, abdomen, back. No visible rash. mild soreness and redness to injection site on left deltoid. 530/6pm developed SOB, rash is now visible, non raised, very itchy trunk. Took 10 mg Zyrtec. Went to ER nausea, vomiting, moderate to severe abdominal pain, flared angina and chest pain with the shortness of breath. ER; DR. CONTINUED WITH BENADRYL 50MG 4-6 HOURS, DUE TO ONGOING ITCHING. FAMOTIDINE 20 MG 2X/DAILY Had flu shot between 09-10/2020 |
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