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This is VAERS ID 1255732

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1255732
VAERS Form:2
Age:70.0
Sex:Male
Location:Louisiana
Vaccinated:2021-02-08
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 2 LA / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Arrhythmia, Chillblains, Myocarditis, Laboratory test normal, Haematology test normal, SARS-CoV-2 test negative

Life Threatening? No
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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: VITAMINS NOS; ASPIRIN (E.C.); VITAMIN D NOS; LOPRESSOR; LIPITOR [ATORVASTATIN CALCIUM]
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210217; Test Name: hematology; Result Unstructured Data: Test Result:Normal; Test Date: 20210217; Test Name: clinical chemistry; Result Unstructured Data: Test Result:Normal; Test Date: 20210222; Test Name: imaging for covid pneumonia; Test Result: Negative
CDC 'Split Type': USPFIZER INC2021432759

Write-up: Myocarditis; Arrhythmia; Chillblains; This is a spontaneous report received from a contactable other Health Care Professional. A 70-year-old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE), dose 2, intramuscular, administered in left deltoid on 08Feb2021 (Lot Number: EL9265), at the age of 70 years, as a single dose for COVID-19 immunization. The patient medical history was not reported. Concomitant medications taken within two weeks of vaccination included vitamins nos, acetylsalicylic acid (ASPIRIN (E.C.), Vitamin D nos, metoprolol tartrate (LOPRESSOR), atorvastatin calcium (LIPITOR). Historical vaccine included BNT162b2, dose 1 on 14Jan2021, lot # EL3216, intramuscular in right deltoid. On an unspecified date, the patient experienced myocarditis, arrhythmia, and chilblains. The patient had lab tests which included haematology test: normal on 17Feb2021, clinical chemistry: normal on 17Feb2021, sars-cov-2 test negative: negative on 22Feb2021. The clinical outcome of the events myocarditis, arrhythmia, and chilblains was unknown.; Sender''s Comments: Based on an implied vaccine-event chronological association, a causal relationship between reported events and PFIZER-BIONTECH COVID-19 mRNA VACCINE cannot be completely excluded. The case will be reevaluated should additional information become available. 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: 1255732 Before After
VAERS Form:2
Age:70.0
Sex:Male
Location:Louisiana
Vaccinated:2021-02-08
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 2 LA / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Arrhythmia, Chillblains, Myocarditis, Laboratory test normal, Haematology test normal, SARS-CoV-2 test negative

Life Threatening? No
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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: VITAMINS NOS; ASPIRIN (E.C.); VITAMIN D NOS; LOPRESSOR; LIPITOR [ATORVASTATIN CALCIUM]
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210217; Test Name: hematology; Result Unstructured Data: Test Result:Normal; Test Date: 20210217; Test Name: clinical chemistry; Result Unstructured Data: Test Result:Normal; Test Date: 20210222; Test Name: imaging for covid pneumonia; Test Result: Negative
CDC 'Split Type': USPFIZER INC2021432759

Write-up: Myocarditis; Arrhythmia; Chillblains; This is a spontaneous report received from a contactable other Health Care Professional. A 70-year-old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE), dose 2, intramuscular, administered in left deltoid on 08Feb2021 (Lot Number: EL9265), at the age of 70 years, as a single dose for COVID-19 immunization. The patient medical history was not reported. Concomitant medications taken within two weeks of vaccination included vitamins nos, acetylsalicylic acid (ASPIRIN (E.C.), Vitamin D nos, metoprolol tartrate (LOPRESSOR), atorvastatin calcium (LIPITOR). Historical vaccine included BNT162b2, dose 1 on 14Jan2021, lot # EL3216, intramuscular in right deltoid. On an unspecified date, the patient experienced myocarditis, arrhythmia, and chilblains. The patient had lab tests which included haematology test: normal on 17Feb2021, clinical chemistry: normal on 17Feb2021, sars-cov-2 test negative: negative on 22Feb2021. The clinical outcome of the events myocarditis, arrhythmia, and chilblains was unknown.; Sender''s Comments: Based on an implied vaccine-event chronological association, a causal relationship between reported events and PFIZER-BIONTECH COVID-19 mRNA VACCINE cannot be completely excluded. The case will be reevaluated should additional information become available. 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: 1255732 Before After
VAERS Form:2
Age:70.0
Sex:Male
Location:Louisiana
Vaccinated:2021-02-08
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 2 LA / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Arrhythmia, Chillblains, Myocarditis, Laboratory test normal, Haematology test normal, SARS-CoV-2 test negative

Life Threatening? No
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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: VITAMINS NOS; ASPIRIN (E.C.); VITAMIN D NOS; LOPRESSOR; LIPITOR [ATORVASTATIN CALCIUM]
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210217; Test Name: hematology; Result Unstructured Data: Test Result:Normal; Test Date: 20210217; Test Name: clinical chemistry; Result Unstructured Data: Test Result:Normal; Test Date: 20210222; Test Name: imaging for covid pneumonia; Test Result: Negative
CDC 'Split Type': USPFIZER INC2021432759

Write-up: Myocarditis; Arrhythmia; Chillblains; This is a spontaneous report received from a contactable other Health Care Professional. A 70-year-old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE), dose 2, intramuscular, administered in left deltoid on 08Feb2021 (Lot Number: EL9265), at the age of 70 years, as a single dose for COVID-19 immunization. The patient medical history was not reported. Concomitant medications taken within two weeks of vaccination included vitamins nos, acetylsalicylic acid (ASPIRIN (E.C.), Vitamin D nos, metoprolol tartrate (LOPRESSOR), atorvastatin calcium (LIPITOR). Historical vaccine included BNT162b2, dose 1 on 14Jan2021, lot # EL3216, intramuscular in right deltoid. On an unspecified date, the patient experienced myocarditis, arrhythmia, and chilblains. The patient had lab tests which included haematology test: normal on 17Feb2021, clinical chemistry: normal on 17Feb2021, sars-cov-2 test negative: negative on 22Feb2021. The clinical outcome of the events myocarditis, arrhythmia, and chilblains was unknown.; Sender''s Comments: Based on an implied vaccine-event chronological association, a causal relationship between reported events and PFIZER-BIONTECH COVID-19 mRNA VACCINE cannot be completely excluded. The case will be reevaluated should additional information become available. 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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