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This is VAERS ID 1320369

History of Changes from the VAERS Wayback Machine

First Appeared on 5/21/2021

VAERS ID: 1320369
VAERS Form:2
Age:
Sex:Male
Location:Florida
Vaccinated:2021-01-01
Onset:2021-05-02
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: Body temperature, Oxygen saturation, Oxygen saturation decreased, Pyrexia, Antibody test negative, SARS-CoV-2 antibody test

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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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