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

This is VAERS ID 1409110



Case Details

VAERS ID: 1409110 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY5420 / 1 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Dysphonia, Feeling abnormal, Infarction, Magnetic resonance imaging, Muscular weakness, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (broad), Anticholinergic syndrome (broad), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? 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:36.7 Centigrade; Test Date: 20210601; Test Name: MRI; Result Unstructured Data: Test Result:new Infarction
CDC Split Type: JPPFIZER INC2021646698

Write-up: infarction; Slight temperature; felt poorly; Muscular weakness; Dysphonia; This is a spontaneous report from a contactable physician received from the Regulatory Authority. The Regulatory authority report number is v21111110. The patient was a 86-year and 5-month female. Body temperature before the vaccinations was 36.7 centigrade. Patient''s history according to the vaccine screening questionnaire was none. Concomitant medications were not reported. On 01Jun2021 at 15:00 (the day of vaccination), the patient received the first single dose of bnt162b2(COMIRNATY Intramuscular injection, Lot number: EY5420, expiration date:31Aug2021) at the age of 86-year-old for COVID-19 immunisation. Adverse event onset date was on 01Jun2021. (as reported). Clinical course of the event was reported as follows: Before the vaccination on 01Jun2021, the patient experienced Neurological disorder on right upper arm. After the vaccination, the patient experienced Slight temperature and felt poorly. After 22:00, the patient visit the hospital. During the examination, the patient experienced Muscular weakness of right upper arm, Dysphonia. MRI confirmed new Infarction. On an unspecific date, the outcome of events was unknown. The reporter classification of seriousness of the event was not provided and the reporter assessed the causality between the event and the vaccines as related. Other possible cause of the event such as any other diseases was Cerebral infarction.


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