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This is VAERS ID 1265961

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1265961
VAERS Form:2
Age:23.0
Sex:Female
Location:Florida
Vaccinated:2021-04-11
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 1 LA / -

Administered by: Unknown      Purchased by: ??
Symptoms: Asthenia, Blindness, Blood pressure increased, Body temperature, Body temperature decreased, Cardiovascular disorder, Chest discomfort, Cyanosis, Dysphagia, Heart rate, Hyperhidrosis, Intracranial pressure increased, Mydriasis, Sinus rhythm, Pulmonary function test, Blood pressure measurement

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: ASMANEX; LEVOCETIRIZINE; MONTELUKAST
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Asthma
Allergies:
Diagnostic Lab Data: Test Date: 20210411; Test Name: BP; Result Unstructured Data: Test Result:137/89; Test Date: 20210411; Test Name: Temp; Result Unstructured Data: Test Result:Low; Test Date: 20210411; Test Name: Pulse; Result Unstructured Data: Test Result:92; Test Date: 20210411; Test Name: Lungs; Result Unstructured Data: Test Result:Clear; Test Date: 20210411; Test Name: sinus rhythm; Result Unstructured Data: Test Result:normal
CDC 'Split Type': USPFIZER INC2021406307

Write-up: This is a spontaneous report from a contactable consumer. A non-pregnant 23-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection), dose 1 via an unspecified route of administration, administered on left arm on 11Apr2021 15:45 (Batch/Lot Number: ER8733) at single dose (at the age of 23 years old) for COVID-19 immunisation. Medical history included asthma. The patient had no known allergies. Concomitant medications included mometasone furoate (ASMANEX), levocetirizine and montelukast, all taken for an unspecified indication, start and stop date were not reported. The patient experienced wit in 10 min extreme weakness, loss of vision with complete pupil dilation not exceeding 5min and without losing complete consciousness. Once vision restored, profuse sweating, pressure cranial to thoracic inlet with moderate difficulty swallowing water. Paramedics arrived. Taken orally 25mg Benadryl. Cyanosis of nail beds and lips, poor perfusion to distal extremities, low temp, normal sinus rhythm, clear lungs, BP 137/89 and pulse 92, all on 11Apr2021. Seen at urgent care within the hour, deemed adverse reaction, ruling out allergic reaction Further concern for possible adverse reaction with second dose. Seeking consult with primary care physician, The patient had no COVID-19 prior vaccination and no COVID-19 test post vaccination. The outcome of the events was recovered on an unspecified date.


Changed on 5/7/2021

VAERS ID: 1265961 Before After
VAERS Form:2
Age:23.0
Sex:Female
Location:Florida
Vaccinated:2021-04-11
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 1 LA / -

Administered by: Unknown      Purchased by: ??
Symptoms: Asthenia, Blindness, Blood pressure increased, Body temperature, Body temperature decreased, Cardiovascular disorder, Chest discomfort, Cyanosis, Dysphagia, Heart rate, Hyperhidrosis, Intracranial pressure increased, Mydriasis, Sinus rhythm, Pulmonary function test, Blood pressure measurement

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: ASMANEX; LEVOCETIRIZINE; MONTELUKAST
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Asthma
Allergies:
Diagnostic Lab Data: Test Date: 20210411; Test Name: BP; Result Unstructured Data: Test Result:137/89; Test Date: 20210411; Test Name: Temp; Result Unstructured Data: Test Result:Low; Test Date: 20210411; Test Name: Pulse; Result Unstructured Data: Test Result:92; Test Date: 20210411; Test Name: Lungs; Result Unstructured Data: Test Result:Clear; Test Date: 20210411; Test Name: sinus rhythm; Result Unstructured Data: Test Result:normal
CDC 'Split Type': USPFIZER INC2021406307

Write-up: This is a spontaneous report from a contactable consumer. A non-pregnant 23-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection), dose 1 via an unspecified route of administration, administered on left arm on 11Apr2021 15:45 (Batch/Lot Number: ER8733) at single dose (at the age of 23 years old) for COVID-19 immunisation. Medical history included asthma. The patient had no known allergies. Concomitant medications included mometasone furoate (ASMANEX), levocetirizine and montelukast, all taken for an unspecified indication, start and stop date were not reported. The patient experienced wit in 10 min extreme weakness, loss of vision with complete pupil dilation not exceeding 5min and without losing complete consciousness. Once vision restored, profuse sweating, pressure cranial to thoracic inlet with moderate difficulty swallowing water. Paramedics arrived. Taken orally 25mg Benadryl. Cyanosis of nail beds and lips, poor perfusion to distal extremities, low temp, normal sinus rhythm, clear lungs, BP 137/89 and pulse 92, all on 11Apr2021. Seen at urgent care within the hour, deemed adverse reaction, ruling out allergic reaction Further concern for possible adverse reaction with second dose. Seeking consult with primary care physician, The patient had no COVID-19 prior vaccination and no COVID-19 test post vaccination. The outcome of the events was recovered on an unspecified date.


Changed on 5/14/2021

VAERS ID: 1265961 Before After
VAERS Form:2
Age:23.0
Sex:Female
Location:Florida
Vaccinated:2021-04-11
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 1 LA / -

Administered by: Unknown      Purchased by: ??
Symptoms: Asthenia, Blindness, Blood pressure increased, Body temperature, Body temperature decreased, Cardiovascular disorder, Chest discomfort, Cyanosis, Dysphagia, Heart rate, Hyperhidrosis, Intracranial pressure increased, Mydriasis, Sinus rhythm, Pulmonary function test, Blood pressure measurement

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: ASMANEX; LEVOCETIRIZINE; MONTELUKAST
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Asthma
Allergies:
Diagnostic Lab Data: Test Date: 20210411; Test Name: BP; Result Unstructured Data: Test Result:137/89; Test Date: 20210411; Test Name: Temp; Result Unstructured Data: Test Result:Low; Test Date: 20210411; Test Name: Pulse; Result Unstructured Data: Test Result:92; Test Date: 20210411; Test Name: Lungs; Result Unstructured Data: Test Result:Clear; Test Date: 20210411; Test Name: sinus rhythm; Result Unstructured Data: Test Result:normal
CDC 'Split Type': USPFIZER INC2021406307

Write-up: This is a spontaneous report from a contactable consumer. A non-pregnant 23-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection), dose 1 via an unspecified route of administration, administered on left arm on 11Apr2021 15:45 (Batch/Lot Number: ER8733) at single dose (at the age of 23 years old) for COVID-19 immunisation. Medical history included asthma. The patient had no known allergies. Concomitant medications included mometasone furoate (ASMANEX), levocetirizine and montelukast, all taken for an unspecified indication, start and stop date were not reported. The patient experienced wit in 10 min extreme weakness, loss of vision with complete pupil dilation not exceeding 5min and without losing complete consciousness. Once vision restored, profuse sweating, pressure cranial to thoracic inlet with moderate difficulty swallowing water. Paramedics arrived. Taken orally 25mg Benadryl. Cyanosis of nail beds and lips, poor perfusion to distal extremities, low temp, normal sinus rhythm, clear lungs, BP 137/89 and pulse 92, all on 11Apr2021. Seen at urgent care within the hour, deemed adverse reaction, ruling out allergic reaction Further concern for possible adverse reaction with second dose. Seeking consult with primary care physician, The patient had no COVID-19 prior vaccination and no COVID-19 test post vaccination. The outcome of the events was recovered on an unspecified date.

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