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

This is VAERS ID 1411980



Case Details

VAERS ID: 1411980 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-03
Onset:2021-06-03
   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 EW4811 / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Anaphylactic reaction, Body temperature, Palpitations
SMQs:, Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)

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:
Allergies:
Diagnostic Lab Data: Test Date: 20210603; Test Name: Body temperature; Result Unstructured Data: Test Result:36.5 Centigrade; Comments: before vaccination
CDC Split Type: JPPFIZER INC2021658358

Write-up: Anaphylaxis; This is a spontaneous report from a contactable physician received from the Regulatory authority report number is V21111649. The patient was a 35-year and 5-month-old female. Body temperature before vaccination was 36.5 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 03Jun2021 at 13:55 (the day of vaccination), (at age of 35-year-old) the patient received the second dose of bnt162b2 (COMIRNATY, Solution for injection, Lot number EW4811, Expiration date 31Jul2021) via an unspecified route of administration as a single dose for COVID-19 immunization. On 03Jun2021 at 14:10 (15 minutes after the vaccination), the patient experienced Anaphylaxis. On 03Jun2021 (the day of vaccination), the patient was admitted to the hospital (physician was Emergency responsible doctor). On unspecified date, the outcome of the event was unknown. The course of the event was as follows: at 13:55 vaccination. Around 14:10, urticaria appeared. After, cough, queasy, a sense of dyspneoa, Palpitations appeared. It was diagnosis as Anaphylaxis and initial response was given. In order to observe the delayed reaction, requested hospital to handle. 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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