|
| VAERS ID: |
903380 (history)
|
| Form: |
Version 2.0 |
| Age: |
50.0 |
| Sex: |
Female |
| Location: |
Texas |
| Vaccinated: | 2020-12-15 |
| Onset: | 2020-12-18 |
| Days after vaccination: | 3 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-18 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
AK5730 / 1 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Ocular hyperaemia,
Swelling,
Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (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: Vitamin C, mirtazapine, tamoxifen, olanzapine, levothyroxine, pantoprazole, lamotrigine, and Immune Response (OTC)
Current Illness: mild seasonal allergies
Preexisting Conditions: breast cancer survivor, hypothyroidism
Allergies: nka
Diagnostic Lab Data:
CDC Split Type:
Write-up: hives all over body. with swelling.. Red eyes. |
|
| VAERS ID: |
903591 (history)
|
| Form: |
Version 2.0 |
| Age: |
41.0 |
| Sex: |
Female |
| Location: |
West Virginia |
| 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 / UNK |
RA / IM |
Administered by: Work Purchased by: ?
Symptoms: Chills,
Feeling jittery,
Lacrimation increased,
Malaise,
Ocular hyperaemia,
Pain,
Photophobia,
Vision blurred
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Noninfectious meningitis (narrow), Glaucoma (broad), Lens disorders (broad), Corneal disorders (broad), Retinal disorders (broad), Lacrimal disorders (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? No
Previous Vaccinations:
Other Medications: Benicar. Allegra. Estrogen Hormone Cream
Current Illness: COVID 19 November 2020
Preexisting Conditions: HTN. Asthma. Interstitial cystitis. Gastritis
Allergies: Norco. Tofranil. Danocrine
Diagnostic Lab Data: N/A
CDC Split Type:
Write-up: Patient reports 1 hour post vaccination symptoms: jittery, feeling lousy. 12/18/20 Am reported bodyaches, red/watery eyes, chills, and blurred vision. States she can see better in dark than in bright lights. Previously hx of COVID 19 illness November 2020. Took Tylenol and Allegra 12/18/20. Reports improvement in symptoms 12/18/20 12:40pm but continues to report mild blurred vision. Advised to seek immediate medical care if condition not improved or worsens. |
|
| VAERS ID: |
904098 (history)
|
| Form: |
Version 2.0 |
| Age: |
58.0 |
| Sex: |
Male |
| Location: |
Illinois |
| Vaccinated: | 2020-12-19 |
| Onset: | 2020-12-19 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-19 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / UNK |
- / - |
Administered by: Private Purchased by: ?
Symptoms: Eye irritation,
Ocular hyperaemia
SMQs:, Anaphylactic reaction (broad), Glaucoma (broad), Corneal 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Burning in eyes, excessive, bloodshot eyes |
|
| VAERS ID: |
904412 (history)
|
| Form: |
Version 2.0 |
| Age: |
57.0 |
| Sex: |
Female |
| Location: |
Missouri |
| Vaccinated: | 2020-12-20 |
| Onset: | 2020-12-20 |
| 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 |
- / IM |
Administered by: Work Purchased by: ?
Symptoms: Feeling abnormal,
Ocular hyperaemia,
Oxygen saturation normal,
Palpitations
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Glaucoma (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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: 9:50 am patient states she does not feel right, feels funny, leaning over in chair, denies SOB no CP c/o of heart racing, NKA RN and RN summoned to help. Patient laid down on floor. BP 192/103 P-112 PO 100%. Eyes noted to be pink, denies itchiness. RN called 911, advised not to give Benadryl. 9:55am BP 178/99 P-119 PO 100% patient continue to feel heart racing but no SOB, chest or throat tightness. 10am BP 177/100 P-114 PO 100% continues to be A&O x3 no resp. distress 10:03 EMS arrived and took her to the ER. Patient states her 15 min observation time was up at 10:05am. RN |
|
| VAERS ID: |
905572 (history)
|
| Form: |
Version 2.0 |
| Age: |
45.0 |
| Sex: |
Male |
| Location: |
Illinois |
| Vaccinated: | 2020-12-20 |
| Onset: | 2020-12-21 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-21 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
RA / SYR |
Administered by: Private Purchased by: ?
Symptoms: Headache,
Lacrimation increased,
Ocular hyperaemia,
Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Glaucoma (broad), Lacrimal disorders (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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:
Write-up: Several running nose that wont stop, Headache, and red watery eyes . |
|
| VAERS ID: |
905800 (history)
|
| Form: |
Version 2.0 |
| Age: |
36.0 |
| Sex: |
Female |
| Location: |
Texas |
| Vaccinated: | 2020-12-16 |
| Onset: | 2020-12-18 |
| Days after vaccination: | 2 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-21 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / UNK |
LA / SYR |
Administered by: Private Purchased by: ?
Symptoms: Eye swelling,
Head discomfort,
Ocular hyperaemia
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Glaucoma (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Acutane Multi vitamins Hair vitamins
Current Illness: None
Preexisting Conditions: Asthma
Allergies: None
Diagnostic Lab Data:
CDC Split Type:
Write-up: Swelling and redness in my left eye. Severe pressure on the left side of head. |
|
| VAERS ID: |
906542 (history)
|
| Form: |
Version 2.0 |
| Age: |
65.0 |
| Sex: |
Female |
| Location: |
Arizona |
| Vaccinated: | 2020-12-18 |
| Onset: | 2020-12-19 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-22 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
UN / SYR |
Administered by: Private Purchased by: ?
Symptoms: Conjunctivitis,
Intraocular pressure test,
Ophthalmological examination,
Uveitis
SMQs:, Severe cutaneous adverse reactions (broad), Conjunctival disorders (narrow), Ocular infections (broad), Hypersensitivity (broad), Immune-mediated/autoimmune 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: Amlodipine, Albuterol prn
Current Illness: None
Preexisting Conditions: HTN, Hypercholesterolemia, Hypothyroid, Pre-DM, Osteoarthritis , Obesity, Asthma
Allergies: Lisinopril, Fluticasone
Diagnostic Lab Data: Dilated eye examination and intraocular pressure testing.
CDC Split Type:
Write-up: Conjunctivitis in both eyes. Uveitis in the right eye. |
|
| VAERS ID: |
907618 (history)
|
| Form: |
Version 2.0 |
| Age: |
42.0 |
| Sex: |
Male |
| Location: |
California |
| Vaccinated: | 2020-12-17 |
| Onset: | 2020-12-17 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-23 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EH9899 / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Arthralgia,
Back pain,
Body temperature increased,
Erythema of eyelid,
Eye pain,
Eyelid oedema,
Hypoacusis,
Myalgia,
Nausea,
Tinnitus
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Eosinophilic pneumonia (broad), Hearing impairment (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Asthma
Preexisting Conditions: Asthma
Allergies: Dogs / cats
Diagnostic Lab Data: None
CDC Split Type:
Write-up: Prior to receiving the vaccine I was feeling well, history of asthma, seasonal and environmental allergies, and no history of significant symptoms after previous vaccinations. Shortly after administration of the COVID-19 vaccine I began to feel nauseous which lasted in duration for approximately 3 days. On the vaccine administration day, several hours after administration I developed retrobulbar pain, bilateral eyelid edema, erythema of the right eyelid, this was one of the most significant symptoms that persisted for several days. In addition, on 12/20 I experienced a several hour episode of tinnitus and diminished auditory acuity in my right ear, this has also resolved. From day 2 until current I have experienced decreasing myalgias and arthralgias, the most significant has been lower back midline pain which has been improving. I developed a temperature of 99.7 Fahrenheit, with administration of acetaminophen. Although the symptoms have improved this is certainly the most significant constellation of symptoms I have experienced after any vaccination. |
|
| VAERS ID: |
908534 (history)
|
| Form: |
Version 2.0 |
| Age: |
30.0 |
| Sex: |
Female |
| Location: |
Ohio |
| Vaccinated: | 2020-12-23 |
| Onset: | 2020-12-23 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-24 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
011J20A / 1 |
LA / IM |
Administered by: Public Purchased by: ?
Symptoms: Eye pruritus,
Flushing,
Lacrimation increased,
Ocular hyperaemia,
Pruritus,
Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Glaucoma (broad), Lacrimal 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: mirtazapine 25mg QHS
Current Illness: none
Preexisting Conditions: none
Allergies: Zofran, Bee stings
Diagnostic Lab Data:
CDC Split Type:
Write-up: Patient started with watery red eyes and face was flushed. initial vital signs after notice of reaction was Bp 120/88 then noticed mild hives on neck and behind ears. Decided to give patient Benedryl 50 mg IM in Right Deltoid at 1:12pm and retook vitals at 1:20 Bp 118/74 pulse 86 and SAO2 99% on room air. Vitals at 1:36 pm were BP 116/84 pulse 90 and SAO2 97% on room air. Redness and eye watering and itching improved. Spoke with patient again today she says she still has a slight itchiness between fingers and will consult physician prior to second dose. |
|
| VAERS ID: |
908641 (history)
|
| Form: |
Version 2.0 |
| Age: |
63.0 |
| Sex: |
Female |
| Location: |
Florida |
| Vaccinated: | 2020-12-21 |
| Onset: | 2020-12-22 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-24 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
011J20A / 1 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Cough,
Eye swelling,
Injection site erythema,
Injection site swelling,
Ocular hyperaemia,
Sleep disorder
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (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? No
Hospitalized? No
Previous Vaccinations: minimal aches with flu vaccine
Other Medications: Edarbyclor 40mg/25mg daily adracet , vitamin D 15mcg, vitamin B complex
Current Illness: no
Preexisting Conditions: healthy
Allergies: no
Diagnostic Lab Data: none
CDC Split Type:
Write-up: About 24 hours after the vaccine, arm became red and swollen at the injection site. Eyes became red and swollen. Experienced coughing if laying flat, had to sleep upright. Symptoms resolved around 12 hours later. |
|
