|
VAERS ID: |
916428 (history) |
Form: |
Version 2.0 |
Age: |
16.0 |
Sex: |
Female |
Location: |
Texas |
Vaccinated: |
2020-12-30 |
Onset: |
2020-12-30 |
Days after vaccination: |
0 |
Submitted: |
0000-00-00 |
Entered: |
2020-12-31 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
037K20A / 1 |
LA / IM |
Administered by: Public Purchased by: ? Symptoms: Pruritus, Urticaria SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), 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? No Hospitalized? No Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: migraines Allergies: Diagnostic Lab Data: N/A CDC Split Type: Write-up: hives and itching face after receiving the vaccination |
|
VAERS ID: |
926611 (history) |
Form: |
Version 2.0 |
Age: |
16.0 |
Sex: |
Male |
Location: |
Missouri |
Vaccinated: |
2020-12-29 |
Onset: |
2021-01-06 |
Days after vaccination: |
8 |
Submitted: |
0000-00-00 |
Entered: |
2021-01-07 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL0140 / 1 |
RA / IM |
Administered by: Private Purchased by: ? Symptoms: Injection site rash, Rash SMQs:, Anaphylactic reaction (broad), 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? Yes ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: Allergies: none Diagnostic Lab Data: CDC Split Type: Write-up: 1/6 a rash developed at the injection site and by 1/7 it had spread to the belly and chest. |
|
VAERS ID: |
930353 (history) |
Form: |
Version 2.0 |
Age: |
16.0 |
Sex: |
Female |
Location: |
Minnesota |
Vaccinated: |
2021-01-07 |
Onset: |
2021-01-08 |
Days after vaccination: |
1 |
Submitted: |
0000-00-00 |
Entered: |
2021-01-08 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EK9231 / 1 |
LA / IM |
Administered by: Private Purchased by: ? Symptoms: Chest discomfort, Discomfort, Dyspnoea, Headache, Pain SMQs:, Anaphylactic reaction (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? No Hospitalized? No Previous Vaccinations: Other Medications: None Current Illness: None Preexisting Conditions: Cardiac murmur LV non-compaction cardiomyopathy Allergies: Penicillin Diagnostic Lab Data: None ordered CDC Split Type: Write-up: Patient in clinic for chief complaint of possible side effect of the covid vaccine which she received yesterday. She states that she woke up at 0200 with chest tightness, achyness and headache. She rates the discomfort 7/10 last night and improved now to 5/10. She denies any worsening with any type of exertion and states that she can do simple things like take a shower, walk across the room, down the street or even stairs without any worsening. She denies any SOB or chest pain--just feels tight. Doesn''t feel like she can''t get a full breath or get the air out of her lungs either. She received her first of two doses of the Pfizer vaccine yesterday (4:23pm) and had no difficulty with the injection itself and then 9.5 hours later woke up from sleep with this chest tightness as well as achyness and headache. ?She states that she had the exact same symptoms when she had positive covid test back in August of this year with the addition of fatigue which lasted for 5 days. At that time it was not felt necessary to do any further testing nor treat with steroids according to cardiology. She does have history of LV non-compaction cardiomyopathy and her last visit with cardiology was about 2 years ago and she had a normal EKG and echo only showed "mild LV non compaction at the apex" at that time. He did not need to see her again until she is 18 unless she has problems. She states that she generally does very well and other than this tightness she does not have any other significant symptoms. |
|
VAERS ID: |
950711 (history) |
Form: |
Version 2.0 |
Age: |
16.0 |
Sex: |
Female |
Location: |
California |
Vaccinated: |
2020-12-29 |
Onset: |
2021-01-15 |
Days after vaccination: |
17 |
Submitted: |
0000-00-00 |
Entered: |
2021-01-16 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL1284 / 1 |
- / SYR |
Administered by: Private Purchased by: ? Symptoms: Periorbital swelling, Pharyngeal swelling, Pruritus, Urticaria SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Periorbital and eyelid disorders (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? No Hospitalized? No Previous Vaccinations: Other Medications: None Current Illness: None. Preexisting Conditions: None. Allergies: Yes, yesterday I broke into hives and right now my eyes are becoming puffy and my throat is swollen. The hives have disappeared when I woke up this morning. Diagnostic Lab Data: None. CDC Split Type: Write-up: Last night I broke out into a bunch of itchy spots that resemble hives all over my body. The hives went away in the morning. Just now, 3:57pm today, I have puffy eyes and a swollen throat. |
|
VAERS ID: |
956925 (history) |
Form: |
Version 2.0 |
Age: |
14.0 |
Sex: |
Male |
Location: |
Georgia |
Vaccinated: |
2021-01-13 |
Onset: |
2021-01-19 |
Days after vaccination: |
6 |
Submitted: |
0000-00-00 |
Entered: |
2021-01-19 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
026L20A / 1 |
RA / IM |
Administered by: Other Purchased by: ? Symptoms: Asthma, Chills, Pyrexia SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (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? No Hospitalized? No Previous Vaccinations: Other Medications: Current Illness: none known at time of vaccine. Preexisting Conditions: Asthma. Allergies: none Diagnostic Lab Data: Chest X-ray showed congestion in the lungs. CDC Split Type: Write-up: The patient received the vaccine and did not have a reaction until Tuesdays the 19th. He had fever and chills. His grandfather signed the consent and told the nurse that he need to have the vaccine because he has asthma. The pediatrician increased his breathing treatment and prescribed antibiotics due to an upper respiratory infect that he had previously. He is now stable and remaining in the home. |
|
VAERS ID: |
1013212 (history) |
Form: |
Version 2.0 |
Age: |
16.0 |
Sex: |
Female |
Location: |
Texas |
Vaccinated: |
2021-01-19 |
Onset: |
2021-01-19 |
Days after vaccination: |
0 |
Submitted: |
0000-00-00 |
Entered: |
2021-02-08 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL0142 / 1 |
LA / IM |
Administered by: Private Purchased by: ? Symptoms: Chest X-ray normal, Dyspnoea, Electrocardiogram normal, Fatigue, SARS-CoV-2 test negative, Tachycardia SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Dehydration (broad), 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? No Hospitalized? No Previous Vaccinations: Other Medications: none reported day of vaccination Current Illness: allergic rhinitis Preexisting Conditions: headaches Allergies: none Diagnostic Lab Data: COVID PCR negative (1/28/21) Chest X-ray normal(1/29/21) EKG - nonspecific ST changes, otherwise normal (2/2/21) CDC Split Type: Write-up: Shortness of breath, fatigue, tachycardia - persisting since vaccination |
|
VAERS ID: |
1036996 (history) |
Form: |
Version 2.0 |
Age: |
16.0 |
Sex: |
Female |
Location: |
California |
Vaccinated: |
2021-02-15 |
Onset: |
2021-02-15 |
Days after vaccination: |
0 |
Submitted: |
0000-00-00 |
Entered: |
2021-02-17 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EN6200 / 1 |
LA / IM |
Administered by: Public Purchased by: ? Symptoms: Chest discomfort, Dizziness, Heart rate increased, Hyperventilation SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Eosinophilic pneumonia (broad), Vestibular disorders (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: None reported Current Illness: Anxiety/panic attacks Preexisting Conditions: None reported Allergies: Bee stings Diagnostic Lab Data: None CDC Split Type: Write-up: 1917 patient reported dizziness, tightness in chest , hyperventilating and pulse rate of 118 bpm. |
|
VAERS ID: |
1045800 (history) |
Form: |
Version 2.0 |
Age: |
16.0 |
Sex: |
Female |
Location: |
Florida |
Vaccinated: |
2021-01-15 |
Onset: |
2021-01-15 |
Days after vaccination: |
0 |
Submitted: |
0000-00-00 |
Entered: |
2021-02-22 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
LA / IM |
Administered by: Private Purchased by: ? Symptoms: Injection site pruritus, Injection site rash, Rash SMQs:, Anaphylactic reaction (broad), 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? Yes ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: Allergies: Amoxicillin, Ampicillin, codeine, Demerol, dilaudid, doxycycline, motrin, penicillin, Zithromax, omnicet Diagnostic Lab Data: CDC Split Type: Write-up: Itching and rash to the injection site, left deltoid. Down left arm shoulder and chest. After a few minutes patient was stable and sent home after monitoring patient. Benadryl was administered at 12:17pm. Patient advised to take Benadryl prior to 2nd dose. |
|
VAERS ID: |
1049830 (history) |
Form: |
Version 2.0 |
Age: |
16.0 |
Sex: |
Female |
Location: |
Georgia |
Vaccinated: |
2021-02-23 |
Onset: |
2021-02-23 |
Days after vaccination: |
0 |
Submitted: |
0000-00-00 |
Entered: |
2021-02-23 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EN6201 / 1 |
LA / IM |
Administered by: Public Purchased by: ? Symptoms: Dizziness, Flushing, Vital signs measurement SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular disorders (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: unknown Current Illness: unknown Preexisting Conditions: unknown Allergies: unknown Diagnostic Lab Data: CDC Split Type: Write-up: "Pfizer-Bio-Tech COVID-19 Vaccine EUA" : Individual received the Pfizer Covid-19 vaccine. She began to feel dizzy and flushed at 1:00 pm. Her vitals were 82/46, 22, 68, 98% RA at1:00 pm. We applied ice to back of neck. B/P 72/42,20, 76 P, 98 % RA. 1:20 pm. Individual report that he had not drink any fluids and only had a few bites to eat. Patient swallowing intact. She was given bottle of water. 1:46 pm vitals were 82/54, 100% SATS, 81, 14. Individual stated she felt better and was not longer dizzy. 1:55 pm vitals 79/54. 14, 78, 98% RA. Individual went home with family with no noted distress. |
|
VAERS ID: |
1055003 (history) |
Form: |
Version 2.0 |
Age: |
16.0 |
Sex: |
Female |
Location: |
Texas |
Vaccinated: |
2021-01-30 |
Onset: |
2021-02-01 |
Days after vaccination: |
2 |
Submitted: |
0000-00-00 |
Entered: |
2021-02-25 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
UN / IM |
Administered by: Private Purchased by: ? Symptoms: Biopsy skin, Chills, Erythema, Headache, Pruritus, Rash papular, Scab, Skin discolouration, Skin lesion, Swelling SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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, ? days Extended hospital stay? No Previous Vaccinations: Other Medications: prednisone, mercaptopurine, methotrexate, vincristine, trimethoprim-sulfamethoxazole, norethindrone, cholecalciferol, calcium carbonate, famotidine Current Illness: currently undergoing chemotherapy for B cell acute lymphoblastic leukemia Preexisting Conditions: B cell acute lymphoblastic leukemia Allergies: shellfish and platelet blood products Diagnostic Lab Data: Due to concern for reactivation of varicella zoster/disseminated varicella zoster, she was urgently biopsied by dermatology on 2/25/21 (result pending) and is currently receiving IV acyclovir. CDC Split Type: Write-up: 1. 48 hours after the first vaccine dose, she developed a raised, red, bump ~4-5cm area on her back with irregular borders. It was slightly itchy but not painful. 2. The area on her back worsened over the next 2-3 weeks and developed dark black scabs. 3. 24 hours after the second vaccine dose (which was given on 2/20/21), she developed scattered lesions on her neck, hairline, ear, face ? some with blisters, some with scabbed tops. Again slightly itchy but not painful. She also had a transient headache and chills that resolved on their own that same day. |
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