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This is VAERS ID 1411987

History of Changes from the VAERS Wayback Machine

First Appeared on 7/23/2021

VAERS ID: 1411987
VAERS Form:2
Age:72.0
Sex:Female
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 EX3617 / 1 - / -

Administered by: Other      Purchased by: ??
Symptoms: Anaphylactic reaction, Body temperature, Eating disorder, Swelling face, Swollen tongue

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: Medical History/Concurrent Conditions: Asthma bronchial
Allergies:
Diagnostic Lab Data: Test Date: 20210604; Test Name: Body temperature; Result Unstructured Data: Test Result:35.9 Centigrade; Comments: before vaccination
CDC 'Split Type': JPPFIZER INC2021658711

Write-up: Anaphylaxis; swelling tongue (left side); swelling left face; she cannot eat or drink; This is a spontaneous report from a contactable physician received from the Regulatory Authority. Regulatory authority report number is v21111924. The patient was a 72-year and 9-month-old female. Body temperature before vaccination was 35.9 degrees Centigrade. The patient''s family history was unknown. There was point 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).: Yes, asthma bronchial. The patient concomitant medications were not reported. On 04Jun2021 at 09:30 (the day of vaccination), the patient received the first dose of bnt162b2 (COMIRNATY, Solution for injection, Lot number EX3617, Expiration date 31Aug2021), at vaccination age of 72 years, via an unspecified route of administration as a single dose for COVID-19 immunization. On 04Jun2021 at 13:30 (4 hours after the vaccination), the patient experienced anaphylaxis, as swelling tongue (left side) and swelling left face. The patient can''t eat. The outcome of the event was recovering, and the outcome date was provided as 05Jun2021 (as reported). The course of the event was as follows: Tongue''s left side and left face were swelling, she cannot eat or drink. The reporting physician classified the event as serious (Can lead to disability) and assessed that the event was related to bnt162b2. There was no other possible cause of the event such as any other diseases. The reporting physician commented as follows: These events had a lot relationship with the vaccination, the patient could not take the second dose.

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