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This is VAERS ID 1411943

History of Changes from the VAERS Wayback Machine

First Appeared on 7/23/2021

VAERS ID: 1411943
VAERS Form:2
Age:88.0
Sex:Male
Location:Foreign
Vaccinated:2021-06-04
Onset:2021-06-04
Submitted:0000-00-00
Entered:2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA5829 / 2 - / -

Administered by: Other      Purchased by: ??
Symptoms: Anaphylactic reaction, Asthma, Body temperature, Cough, Heart rate, Oxygen saturation, Oxygen saturation decreased, 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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210604; Test Name: BP; Result Unstructured Data: Test Result:160/86; Comments: 14:26; Test Date: 20210604; Test Name: BP; Result Unstructured Data: Test Result:157/71; Comments: 14:46; Test Date: 20210604; Test Name: body temperature; Result Unstructured Data: Test Result:36.6 Centigrade; Comments: before vaccination; Test Date: 20210604; Test Name: P; Result Unstructured Data: Test Result:94; Comments: 14:26; Test Date: 20210604; Test Name: P; Result Unstructured Data: Test Result:74; Comments: 14:30; Test Date: 20210604; Test Name: P; Result Unstructured Data: Test Result:74; Comments: 14:34; Test Date: 20210604; Test Name: P; Result Unstructured Data: Test Result:79; Comments: 14:37; Test Date: 20210604; Test Name: P; Result Unstructured Data: Test Result:78; Comments: 14:44; Test Date: 20210604; Test Name: P; Result Unstructured Data: Test Result:75; Comments: 14:46; Test Date: 20210604; Test Name: Spo2; Test Result: 91 %; Comments: 14:24; Test Date: 20210604; Test Name: Spo2; Test Result: 95 %; Comments: 14:26; Test Date: 20210604; Test Name: Spo2; Test Result: 92 %; Comments: 14:30; Test Date: 20210604; Test Name: Spo2; Test Result: 98 %; Comments: 14:34; Test Date: 20210604; Test Name: Spo2; Test Result: 97 %; Comments: 14:37; Test Date: 20210604; Test Name: Spo2; Test Result: 97 %; Comments: 14:44
CDC 'Split Type': JPPFIZER INC2021656255

Write-up: asthma; Spo2 decreased to 91%; Anaphylaxis; cough; This is a spontaneous report from a contactable physician received from the Regulatory Authority. Regulatory authority report number is. The patient was an 88-year and 3-month-old male. Body temperature before vaccination was 36.6 degrees 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 04Jun2021 at 14:12, the patient received the second dose of bnt162b2 (COMIRNATY, Solution for injection, Lot number FA5829, Expiration date 31Aug2021) at the age of 88-year-old via an unspecified route of administration as a single dose for COVID-19 immunization. The patient previously took first dose of bnt162b2 (COMIRNATY) for covid-19 immunization. On 04Jun2021 at 14:23 , the patient experienced events. On 04Jun2021 , the outcome of the event was recovering. The course of the event was as follows: On 04Jun2021 at 14:23, cough occurred. On 04Jun2021 at 14:24, Spo2 decreased to 91% and the patient started wearing oxygen masks. On 04Jun2021 at 14:26, BP was 160/86, P94 Spo2 95%. On 04Jun2021 at 14:30, the patient developed asthma, Spo2 92% P74. On 04Jun2021 at 14:33, BOSMIN 0.3mg was given via intramuscular. On 04Jun2021 at 14:34, Spo2 was 98% P74, normal saline 500ml was given to establish infusion route. On 04Jun2021 at 14:37, solu-medrol 125mg+normal saline 100ml were administered, asthma disappeared. Spo2 was 97% P79. On 04Jun2021 at 14:43, nasal cannula 1 L/min. On 04Jun2021 at 14:44, Spo2 was 97%, P78. On 04Jun2021 at 14:46, BP was157/71, P75. On 04Jun2021 at 14:50, the first-aid team arrived. The reporting physician classified the event as serious(hospitalization from 04Jun2021 to 05Jun2021) and assessed that the event was related to bnt162b2. There was no other possible cause of the event such as any other diseases. This report meet the criteria of Anaphylaxis.

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