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This is VAERS ID 1135577

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1135577
VAERS Form:2
Age:17.0
Sex:Female
Location:Hawaii
Vaccinated:2021-03-08
Onset:2021-03-16
Submitted:0000-00-00
Entered:2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 1 RA / OT

Administered by: Military      Purchased by: ??
Symptoms: Body temperature, C-reactive protein, Electroencephalogram, Full blood count, Headache, Lumbar puncture, Nausea, Pyrexia, Seizure, Vision blurred, Vomiting, Drug screen, Magnetic resonance imaging, SARS-CoV-2 test

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Hospitalization
Preexisting Conditions: Medical History/Concurrent Conditions: Headache; Irregular periods
Allergies:
Diagnostic Lab Data: Test Date: 20210316; Test Name: Body Temperature; Result Unstructured Data: Test Result:100.4 Fahrenheit; Test Name: CRP; Result Unstructured Data: Test Result:elevated to 0.8 (normal less than 0.5); Test Name: Tox screen; Result Unstructured Data: Test Result:negative; Test Name: EEG; Result Unstructured Data: Test Result:shows localized to the occipital region; Test Name: CBC; Result Unstructured Data: Test Result:unremarkable; Test Name: LP; Result Unstructured Data: Test Result:shows 1 WBC, Gram stain negative; Test Name: MRI with contrast negative; Test Result: Negative ; Test Date: 20210317; Test Name: Nasal Swab; Test Result: Negative
CDC 'Split Type': USPFIZER INC2021300044

Write-up: Began having seizures; Presented to the ER on 17 March 2021 for headache with blurry vision; Presented to the ER on 17 March 2021 for headache with blurry vision; Also had persistent nausea and subsequent vomiting; Also had persistent nausea and subsequent vomiting; Fever X1 to 100.4F on day of presentation/no further sz; This is a spontaneous report from a contactable physician. A 17-year-old female patient (not pregnant) received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) intramuscularly in right arm on 08Mar2021 (lot number: EN6206) at single dose for COVID-19 immunization. Medical history included headache and irregular periods, ongoing hospitalization. No known allergies. Concomitant medications included birth control pills. No other vaccine in four weeks. No COVID prior vaccination. Vaccine received during existing hospitalization. The patient began having seizures (hospitalization prolonged, life threatening) on 16Mar2021 12:00, presented to the ER on 17Mar2021 for headache with blurry vision (hospitalization prolonged, life threatening) on 16Mar2021 12:00, also had persistent nausea and subsequent vomiting (hospitalization prolonged, life threatening) on 16Mar2021 12:00, fever x1 to 100.4F on day of presentation/no further seizure (hospitalization prolonged, life threatening) on 16Mar2021 12:00. Clinical course: Presented to the ER on 17March2021 for headache with blurry vision. Patient reported symptoms for 1 day prior. Also had persistent nausea and subsequent vomiting. Presented to the ED at 23:00. Began having seizures. EEG shows localized to the occipital region. Fever X1 to 100.4F on day of presentation no further sz. LP shows 1 WBC, Gram stain negative. Cultures negative. HSV pending. On ceftriaxone and acyclovir. Continues to have focal sz on EEG now on 3 AEDs. MRI with contrast negative. CBC unremarkable. CRP elevated to 0.8 (normal less than 0.5). Tox screen negative. COVID tested post vaccination: Nasal Swab (SARS-CoV-2 Cepheid) with result of negative on 17Mar2021. Therapeutic measures were taken as a result of all the events which included treatment with IVIG, Antibiotics, Steroids, Antiepileptics. The outcome of the events was not recovered.; Sender''s Comments: Based on the information currently available, a possible contributory role of the suspect drug to the reported events cannot be completely excluded based on temporal association and known drug safety profile. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.


Changed on 5/7/2021

VAERS ID: 1135577 Before After
VAERS Form:2
Age:17.0
Sex:Female
Location:Hawaii
Vaccinated:2021-03-08
Onset:2021-03-16
Submitted:0000-00-00
Entered:2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 1 RA / OT

Administered by: Military      Purchased by: ??
Symptoms: Body temperature, C-reactive protein, Electroencephalogram, Full blood count, Headache, Lumbar puncture, Nausea, Pyrexia, Seizure, Vision blurred, Vomiting, Drug screen, Magnetic resonance imaging, SARS-CoV-2 test

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Hospitalization
Preexisting Conditions: Medical History/Concurrent Conditions: Headache; Irregular periods
Allergies:
Diagnostic Lab Data: Test Date: 20210316; Test Name: Body Temperature; Result Unstructured Data: Test Result:100.4 Fahrenheit; Test Name: CRP; Result Unstructured Data: Test Result:elevated to 0.8 (normal less than 0.5); Test Name: Tox screen; Result Unstructured Data: Test Result:negative; Test Name: EEG; Result Unstructured Data: Test Result:shows localized to the occipital region; Test Name: CBC; Result Unstructured Data: Test Result:unremarkable; Test Name: LP; Result Unstructured Data: Test Result:shows 1 WBC, Gram stain negative; Test Name: MRI with contrast negative; Test Result: Negative ; Test Date: 20210317; Test Name: Nasal Swab; Test Result: Negative
CDC 'Split Type': USPFIZER INC2021300044

Write-up: Began having seizures; Presented to the ER on 17 March 2021 for headache with blurry vision; Presented to the ER on 17 March 2021 for headache with blurry vision; Also had persistent nausea and subsequent vomiting; Also had persistent nausea and subsequent vomiting; Fever X1 to 100.4F on day of presentation/no further sz; This is a spontaneous report from a contactable physician. A 17-year-old female patient (not pregnant) received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) intramuscularly in right arm on 08Mar2021 (lot number: EN6206) at single dose for COVID-19 immunization. Medical history included headache and irregular periods, ongoing hospitalization. No known allergies. Concomitant medications included birth control pills. No other vaccine in four weeks. No COVID prior vaccination. Vaccine received during existing hospitalization. The patient began having seizures (hospitalization prolonged, life threatening) on 16Mar2021 12:00, presented to the ER on 17Mar2021 for headache with blurry vision (hospitalization prolonged, life threatening) on 16Mar2021 12:00, also had persistent nausea and subsequent vomiting (hospitalization prolonged, life threatening) on 16Mar2021 12:00, fever x1 to 100.4F on day of presentation/no further seizure (hospitalization prolonged, life threatening) on 16Mar2021 12:00. Clinical course: Presented to the ER on 17March2021 for headache with blurry vision. Patient reported symptoms for 1 day prior. Also had persistent nausea and subsequent vomiting. Presented to the ED at 23:00. Began having seizures. EEG shows localized to the occipital region. Fever X1 to 100.4F on day of presentation no further sz. LP shows 1 WBC, Gram stain negative. Cultures negative. HSV pending. On ceftriaxone and acyclovir. Continues to have focal sz on EEG now on 3 AEDs. MRI with contrast negative. CBC unremarkable. CRP elevated to 0.8 (normal less than 0.5). Tox screen negative. COVID tested post vaccination: Nasal Swab (SARS-CoV-2 Cepheid) with result of negative on 17Mar2021. Therapeutic measures were taken as a result of all the events which included treatment with IVIG, Antibiotics, Steroids, Antiepileptics. The outcome of the events was not recovered.; Sender''s Comments: Based on the information currently available, a possible contributory role of the suspect drug to the reported events cannot be completely excluded based on temporal association and known drug safety profile. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.


Changed on 5/14/2021

VAERS ID: 1135577 Before After
VAERS Form:2
Age:17.0
Sex:Female
Location:Hawaii
Vaccinated:2021-03-08
Onset:2021-03-16
Submitted:0000-00-00
Entered:2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 1 RA / OT

Administered by: Military      Purchased by: ??
Symptoms: Body temperature, C-reactive protein, Electroencephalogram, Full blood count, Headache, Lumbar puncture, Nausea, Pyrexia, Seizure, Vision blurred, Vomiting, Drug screen, Magnetic resonance imaging, SARS-CoV-2 test

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Hospitalization
Preexisting Conditions: Medical History/Concurrent Conditions: Headache; Irregular periods
Allergies:
Diagnostic Lab Data: Test Date: 20210316; Test Name: Body Temperature; Result Unstructured Data: Test Result:100.4 Fahrenheit; Test Name: CRP; Result Unstructured Data: Test Result:elevated to 0.8 (normal less than 0.5); Test Name: Tox screen; Result Unstructured Data: Test Result:negative; Test Name: EEG; Result Unstructured Data: Test Result:shows localized to the occipital region; Test Name: CBC; Result Unstructured Data: Test Result:unremarkable; Test Name: LP; Result Unstructured Data: Test Result:shows 1 WBC, Gram stain negative; Test Name: MRI with contrast negative; Test Result: Negative ; Test Date: 20210317; Test Name: Nasal Swab; Test Result: Negative
CDC 'Split Type': USPFIZER INC2021300044

Write-up: Began having seizures; Presented to the ER on 17 March 2021 for headache with blurry vision; Presented to the ER on 17 March 2021 for headache with blurry vision; Also had persistent nausea and subsequent vomiting; Also had persistent nausea and subsequent vomiting; Fever X1 to 100.4F on day of presentation/no further sz; This is a spontaneous report from a contactable physician. A 17-year-old female patient (not pregnant) received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) intramuscularly in right arm on 08Mar2021 (lot number: EN6206) at single dose for COVID-19 immunization. Medical history included headache and irregular periods, ongoing hospitalization. No known allergies. Concomitant medications included birth control pills. No other vaccine in four weeks. No COVID prior vaccination. Vaccine received during existing hospitalization. The patient began having seizures (hospitalization prolonged, life threatening) on 16Mar2021 12:00, presented to the ER on 17Mar2021 for headache with blurry vision (hospitalization prolonged, life threatening) on 16Mar2021 12:00, also had persistent nausea and subsequent vomiting (hospitalization prolonged, life threatening) on 16Mar2021 12:00, fever x1 to 100.4F on day of presentation/no further seizure (hospitalization prolonged, life threatening) on 16Mar2021 12:00. Clinical course: Presented to the ER on 17March2021 for headache with blurry vision. Patient reported symptoms for 1 day prior. Also had persistent nausea and subsequent vomiting. Presented to the ED at 23:00. Began having seizures. EEG shows localized to the occipital region. Fever X1 to 100.4F on day of presentation no further sz. LP shows 1 WBC, Gram stain negative. Cultures negative. HSV pending. On ceftriaxone and acyclovir. Continues to have focal sz on EEG now on 3 AEDs. MRI with contrast negative. CBC unremarkable. CRP elevated to 0.8 (normal less than 0.5). Tox screen negative. COVID tested post vaccination: Nasal Swab (SARS-CoV-2 Cepheid) with result of negative on 17Mar2021. Therapeutic measures were taken as a result of all the events which included treatment with IVIG, Antibiotics, Steroids, Antiepileptics. The outcome of the events was not recovered.; Sender''s Comments: Based on the information currently available, a possible contributory role of the suspect drug to the reported events cannot be completely excluded based on temporal association and known drug safety profile. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.

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