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This is VAERS ID 1409108

History of Changes from the VAERS Wayback Machine

First Appeared on 7/23/2021

VAERS ID: 1409108
VAERS Form:2
Age:65.0
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 EY2173 / 2 - / -

Administered by: Other      Purchased by: ??
Symptoms: Body temperature, Hypersensitivity, Pruritus, Rash

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: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data: Test Date: 20210601; Test Name: Body temperature; Result Unstructured Data: Test Result:36.3 Centigrade; Comments: before vaccination
CDC 'Split Type': JPPFIZER INC2021646565

Write-up: itching and mild rash appeared on the extremities; itching and mild rash appeared on the extremities; allergic reaction; This is a spontaneous report from a contactable physician received from The regulatory authority report number is v21111095. The patient was a 65-year-old female. Body temperature before vaccination was 36.3 Centigrade. There were no points to be considered on the 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). On 01Jun2021 at 16:00 (the day of vaccination), the patient received the second dose of bnt162b2 (COMIRNATY, Solution for injection, Lot number EY2173, Expiration date 31Aug2021) at the age of 65-year-old via an unspecified route of administration as a single dose for COVID-19 immunization. The event onset date was reported as 01Jun2021 at 17:00 (as reported) (1 hours after the vaccination). The course of the event was as follows: Approximately 30 minutes after the vaccination (as reported), itching and mild rash appeared on the extremities. There was no blood pressure decreased and normal breathing sound. It was considered that the allergic reaction was caused by the vaccination, and the antihistamine was injected. The symptoms were recovering after 15 minutes of treatment. On 01Jun2021 (the same day of vaccination), the outcome of the events was recovering. The reporter classified the event as non-serious and assessed that the event was related to bnt162b2. There was no other possible cause of the event such as any other diseases. The reporter commented as follows: It was believed to be a mild allergic reaction caused by vaccination.

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