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This is VAERS ID 1404771

History of Changes from the VAERS Wayback Machine

First Appeared on 7/23/2021

VAERS ID: 1404771
VAERS Form:2
Age:81.0
Sex:Female
Location:Foreign
Vaccinated:2021-06-01
Onset:2021-06-01
Submitted:0000-00-00
Entered:2021-06-17
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 increased, Body temperature, Dyspnoea, Heart rate increased, Oxygen saturation, Pulse abnormal, Somnolence, Eyelid function disorder, Blood pressure measurement

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: MENESIT
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Anaphylactic shock due to adverse food reaction; Parkinson''s disease
Allergies:
Diagnostic Lab Data: Test Date: 20210601; Test Name: BP; Result Unstructured Data: Test Result:124/72; Comments: 15:30; Test Date: 20210601; Test Name: BP; Result Unstructured Data: Test Result:170/88; Comments: 15:43; Test Date: 20210601; Test Name: BP; Result Unstructured Data: Test Result:134/73; Comments: 15:45; Test Date: 20210601; Test Name: BP; Result Unstructured Data: Test Result:122/62; Comments: 16:00; Test Date: 20210601; Test Name: Body temperature; Result Unstructured Data: Test Result:36.7 Centigrade; Comments: before vaccination; Test Date: 20210601; Test Name: spo2; Test Result: 98 %; Comments: 15:30; Test Date: 20210601; Test Name: spo2; Test Result: 98 %; Comments: 16:10; Test Date: 20210601; Test Name: pulse; Result Unstructured Data: Test Result:82; Comments: 15:30; Test Date: 20210601; Test Name: pulse; Result Unstructured Data: Test Result:108; Comments: 15:43; Test Date: 20210601; Test Name: pulse; Result Unstructured Data: Test Result:113; Comments: 15:45; Test Date: 20210601; Test Name: pulse; Result Unstructured Data: Test Result:102; Comments: 16:00
CDC 'Split Type': JPPFIZER INC2021635543

Write-up: BP was 170/88; P was equal to 108; Sleepiness; Dyspnoea; Difficult to open eyes; This is a spontaneous report. The patient was an 81-year-old and 4 months non-pregnant female patient. Body temperature before vaccination was 36.7 degrees Centigrade. The patient''s family history was not reported. Patient''s vaccine screening questionnaire (primary diseases, allergies, vaccinations and illnesses within the last one month, medications the patient was taking, past adverse effect history, growth status, etc.) included Anaphylactic shock caused by using Flomox, yam and taro. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. The patient received Menesit within 2 weeks of vaccination. Prior to vaccination, the patient was not diagnosed with COVID-19. On 01Jun2021 (at the age of 81-years-old) at 15:15 (the day of vaccination) (as reported), the patient received the first single dose of BNT162B2 (COMIRNATY, Solution for injection, Lot number EY4834, Expiration date 31Aug2021) via intramuscular, administered in arm left at single dose for COVID-19 immunization. Event onset date was reported as: 01Jun2021 at 15:30. On 01Jun2021, Event outcome was reported as recovered. The course of the event was as follows: From the beginning, the patient experienced sleepiness and dyspnoea. Difficult to open eyes. SpO2 was 98%, BP was 124/72, P was 82. At 15:35, with ensure venous access, infusion of physio35 500ml was provided. At 15:40, Bosmin vis intramuscular injection was provided with adding 1.65 mg of Decadron in the bottle. At 15:43, BP was 170/88, P was equal to 108. Loosen the drip drop speed. At 15:45, BP was 134/73, P was equal to 113. At 16:00, BP was 122/62, P was equal to 102. At 16:10, dyspnea disappeared and SpO2 was 98%. The event resulted in Doctor or other healthcare professional office/clinic visit. The outcome of the events was recovered with treatment including Adrenaline injection and intravenous treatment. Since the vaccination, the patient has not been tested for COVID-19. The reporting physician classified the event as non-serious and assessed that the causality between the event and bnt162b2 as related. Other possible cause of the event such as any other diseases was not provided. Reporter''s comment: Anaphylactic shock caused by using Flomox, yam and taro.

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