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From the 9/17/2021 release of VAERS data:

This is VAERS ID 1411940



Case Details

VAERS ID: 1411940 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA4597 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Anaphylactic reaction, Blood pressure decreased, Blood pressure measurement, Cough, Dyspnoea, Erythema, Heart rate, Heart rate increased, Nausea, Oxygen saturation, Pruritus, Respiratory rate, Respiratory rate increased
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Seafood allergy
Allergies:
Diagnostic Lab Data: Test Date: 20210604; Test Name: blood pressure; Result Unstructured Data: Test Result:58; Test Date: 20210604; Test Name: pulse rate; Result Unstructured Data: Test Result:112; Test Date: 20210604; Test Name: SPO2; Result Unstructured Data: Test Result:98 to 99 %; Test Date: 20210604; Test Name: respiratory rate; Result Unstructured Data: Test Result:32
CDC Split Type: JPPFIZER INC2021656239

Write-up: Anaphylaxis; Dyspnoea; Redness around the neck/Redness with thigh; itching/itching with thigh; cough; Nausea; Respiratory rate was 32; Pulse rate was 112; blood pressure was 58; This is a spontaneous report from a contactable physician received from the Regulatory Agency. Regulatory authority report number is v21111866. A 49-year-old female patient received the first dose of BNT162B2 (COMIRNATY, Solution for injection, Lot number FA4597, Expiration date 31Aug2021) via an unspecified route of administration on 04Jun2021 at 16:00 at age of 49 years old as single dose for COVID-19 immunization. Medical history included shrimp allergy. Concomitant medications were unknown. The patient previously received lidocaine (XYLOCAINE) and experienced drug allergy. The course of the event was as follows: On 04Jun2021 at 16:05 (5 minutes after the vaccination, as reported), the patient experienced Dyspnoea, Redness around the neck, Itching, Cough, Nausea, Redness with thigh and itching. And Pulse rate was 112, respiratory rate was 32, blood pressure was 58, SPO2 was 98 to 99 %.The patient began to inhale oxygen, BOSMIN 0.3mg, Atarax-P 25 mg Intramuscular, Meptin air 2 push was enforced. Secure the route and 100 ml of saline and Solu-Medrol 125mg was administration. The patient was hospitalized. This report meet the criteria of Anaphylaxis. The outcome of the events were unknown. The reporting physician classified the event as serious (Hospitalized) and assessed that the event was related to BNT162B2. There was no other possible cause of the event such as any other diseases.


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