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From the 7/23/2021 release of VAERS data:

This is VAERS ID 1320369



Case Details

VAERS ID: 1320369 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Florida  
Vaccinated:2021-01-01
Onset:2021-05-02
   Days after vaccination:121
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / -

Administered by: Public       Purchased by: ?
Symptoms: Antibody test negative, Body temperature, Oxygen saturation, Oxygen saturation decreased, Pyrexia, SARS-CoV-2 antibody test
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), COVID-19 (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: PRISTIQ; LAMICTAL; SIMVASTATIN
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data: Test Date: 20210502; Test Name: body temperature; Result Unstructured Data: Test Result:103; Test Date: 20210502; Test Name: body temperature; Result Unstructured Data: Test Result:104; Test Date: 20210502; Test Name: Oxygen saturation; Result Unstructured Data: Test Result:84; Test Date: 20210502; Test Name: Oxygen saturation; Result Unstructured Data: Test Result:82; Test Date: 20210503; Test Name: COVID-19 antibody test; Test Result: Negative
CDC Split Type: USPFIZER INC2021522752

Write-up: fever of 103/104; Oxigen level of 82 / 84; No antibodies against COVID-19; This is a spontaneous report from a contactable consumer (patient). A male patient of an unspecified age received the 2nd dose of bnt162b2 (BNT162B2, Manufacturer Pfizer-BioNTech), via an unspecified route of administration in arm right, in Jan2021, at single dose, for COVID-19 immunisation. Patient had no known allergies or other medical history. The patient was not diagnosed with COVID-19 prior to vaccination. Concomitant medications included desvenlafaxine succinate (PRISTIQ), lamotrigine (LAMICTAL), simvastatin (unknown manufacturer). The patient did not receive any other vaccines within 4 weeks prior to the COVID-19 vaccine. Previously the patient received the 1st dose of bnt162b2 (BNT162B2, Manufacturer Pfizer-BioNTech) for COVID-19 immunisation on unknown date in right arm. The patient experienced fever of 103/104 (caused hospitalization, life threatening) on 02May2021 at 08:00 AM with outcome of unknown, oxygen level of 82 / 84 (caused hospitalization, life threatening) on 02May2021 at 08:00 AM with outcome of unknown, no antibodies against COVID-19 (life threatening) on 03May2021 with outcome of unknown. The events pyrexia and oxygen saturation decreased required physician office visit and emergency room visit. Therapeutic measures were taken as a result of pyrexia and oxygen saturation decreased and included treatment with oxygen, antibiotics, fluids. After 8 hours the patient was sent to the ICU. The patient underwent lab tests and procedures which included body temperature: 103 on 02May2021, body temperature: 104 on 02May2021, oxygen saturation: 84 on 02May2021, oxygen saturation: 82 on 02May2021, COVID-19 antibody test: negative on 03May2021. The information on the lot/batch number has been requested.


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