National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1409083

History of Changes from the VAERS Wayback Machine

First Appeared on 7/23/2021

VAERS ID: 1409083
VAERS Form:2
Age:67.0
Sex:Female
Location:Foreign
Vaccinated:2021-06-01
Onset:2021-06-01
Submitted:0000-00-00
Entered:2021-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY5420 / 1 - / -

Administered by: Other      Purchased by: ??
Symptoms: Body temperature, Drug eruption, Urticaria, Vital signs measurement, Blood pressure measurement

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Anesthesia procedure; Fracture; Urticaria
Allergies:
Diagnostic Lab Data: Test Date: 20210601; Test Name: blood pressure; Result Unstructured Data: Test Result:normal; Test Date: 20210601; Test Name: Body temperature; Result Unstructured Data: Test Result:36.5 Centigrade; Test Date: 20210601; Test Name: vital sign; Result Unstructured Data: Test Result:normal
CDC 'Split Type': JPPFIZER INC2021644419

Write-up: Drug eruption; urticaria began to appear on the back; This is a spontaneous report from the contactable physician received from the regulatory authority report number is v21110933. The patient was 67-year and 2-month-old female. Body temperature before the vaccination was 36.5 degrees Centigrade. The patient had none family history. Patient''s history according to the Vaccine Screening Questionnaire (including underlying diseases, allergies, vaccinations received or diseases developed within the last month, medications used, past adverse drug reaction history, and growth status) included usually, when the physical condition was not good, urticaria may also appeared, but it all subsided naturally. On 10Mar2021, after a general Anesthesia procedure due to fracture, mild urticaria appeared, but it subsided naturally. The causal relationship with anesthetics was unknown. On 01Jun2021 at 15:45 (the day of vaccination), the patient received the first dose of bnt162b2 (COMIRNATY Intramuscular injection, Lot number: EY5420, expiration date: 31Aug2021) via an unspecified route of administration at a single dose (at the age of 67-years-old) for COVID-19 immunization. Event onset date was reported on 01Jun2021 at 15:50. Clinical course of the event was reported as follows: On 01Jun2021 at 15:45 (same day of vaccination), first dose of vaccination (COMIRNATY intramuscular injection Pfizer) performed. No special rash before injection. Five (5) minutes after the injection, (around 15:50) urticaria began to appear on the back, then spread to the abdomen and upper arms, but there were no systemic reactions such as wheezing and dyspnoea, Blood pressure and vital signs were also normal. Symptoms improved after oral administration of Bilanoa and infusion of Solu-cortef (250). The event term was reported as drug eruption. The reporter classified the event as non-serious and assessed the causality between the event and the vaccine as related. There was no other possible cause of the events such as any other diseases. On 01Jun2021 (same day of vaccination), the outcome of the events was recovering. The reporter commented as follows: it seemed that there was a causal relationship, and the symptoms were recovering after treatment.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1409083&WAYBACKHISTORY=ON


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