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From the 9/10/2021 release of VAERS data:

This is VAERS ID 1401329



Case Details

VAERS ID: 1401329 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY4834 / 1 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure decreased, Bradycardia, Depressed level of consciousness, Feeling abnormal
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: JPPFIZER INC2021636246

Write-up: Consciousness clouding; Bradycardia; Feels poorly; blood pressure decreased; This is a spontaneous report from a contactable physician received via COVID-19 Vaccine Adverse Event Reporting System (COVAES). The patient was a 29-year-old male. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. The patient did not receive any other medications within 2 weeks of vaccination. Prior to vaccination, the patient was not diagnosed with COVID-19. The patient had no allergies to medications, food, or other products. The patient medical history was reported as healthy without illness. On 01Jun2021 at 0:00 (the day of vaccination), the patient received the first single dose of BNT162B2 (COMIRNATY, Solution for injection, Lot number EY4834, Expiration date 31Aug2021), at vaccination age of 29 years, intramuscular route of administration in arm left for COVID-19 immunization. On 01Jun2021 at 0:00 (as reported, same time after vaccination), 10 minutes after the vaccination, the patient experienced Feels poorly, consciousness clouding. No urticaria, pruritus generalised, asthma-like attack, and gastrointestinal symptoms were observed. Blood pressure decreased and bradycardia were observed. The patient kept lying on the bed with lower limb elevation. The patient was treated with normal saline drip infusion and the blood pressure increased, consciousness recovered to normal. The events resulted in Emergency room/department or urgent care. The outcome of the events was recovered with treatment including drop infusion. Since the vaccination, the patient has not been tested for COVID-19.


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