National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1409062

History of Changes from the VAERS Wayback Machine

First Appeared on 7/23/2021

VAERS ID: 1409062
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other      Purchased by: ??
Symptoms: Altered state of consciousness, Anaphylactic reaction, Blood pressure decreased, Body temperature, Chills, Depressed level of consciousness, Heart rate, Nausea, Tachycardia, Urticaria, Vomiting, 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)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: Test Date: 20210601; Test Name: Blood pressure; Result Unstructured Data: Test Result:140s-110s; Comments: Blood pressure dropped; Test Date: 20210601; Test Name: Body temperature; Result Unstructured Data: Test Result:36.5 Centigrade; Comments: before vaccination; Test Date: 20210601; Test Name: HR; Result Unstructured Data: Test Result:120
CDC 'Split Type': JPPFIZER INC2021643133

Write-up: Anaphylaxis; Consciousness disturbance transient; decreased consciousness level; Tachycardia; systemic urticaria; Chills; Nausea; Vomiting; blood pressure slightly decreased from about 140s to about 110s; This is a spontaneous report from a contactable physician received from the Regulatory Authority, report number is v21111204. A 32-year and 2-month-old female patient received second dose of BNT162b2 (COMIRNATY), via an unspecified route of administration on 01Jun2021 at 09:48 (Lot Number: EY2173; Expiration Date: 31Aug2021) (at the age of 32-year-old) as single dose for COVID-19 immunisation. Body temperature before vaccination was 36.5 degrees Centigrade. The patient previously received first dose of BNT162b2 (COMIRNATY), via an unspecified route of administration on an unspecified date as single dose for COVID-19 immunisation and experienced vaccination site pruritus. On 01Jun2021 at 09:48 (the day of vaccination), the patient received the second dose of BNT162B2 (COMIRNATY). On 01Jun2021 at 10:00 (12 minutes after the vaccination), the patient experienced anaphylaxis, consciousness disturbance transient, tachycardia, urticaria. On 01Jun2021, the patient was admitted to the hospital. On 02Jun2021, the outcome of the events was recovered. The course of the event was as follows: 12 minutes after the second inoculation, it was confirmed that allergic symptoms (Brighton classification grade 2-3), systemic urticaria, tachycardia (HR120), decreased blood pressure (from 140 to 110), decreased consciousness level (1), and blood pressure slightly decreased from about 140s to about 110s. The symptoms of chills, nausea and vomiting improved rapidly after infusion. In order to observe the situation, the patient was hospitalized and discharged after recovery. After recovery, atrial frequency was also confirmed and external follow-up was decided. The reporting physician classified the event as serious (hospitalization from 01Jun2021 to 02Jun2021) and assessed that the events were related to BNT162B2. There was no other possible cause of the event such as any other diseases. The reporting physician commented as follows: the patient said that after the first vaccination, there was pruritus at the vaccination site.

New Search

Link To This Search Result:

Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166