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This is VAERS ID 1415937

History of Changes from the VAERS Wayback Machine

First Appeared on 7/23/2021

VAERS ID: 1415937
VAERS Form:2
Age:
Sex:Female
Location:Foreign
Vaccinated:2021-06-03
Onset:2021-06-04
Submitted:0000-00-00
Entered:2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW3143 / 1 - / -

Administered by: Other      Purchased by: ??
Symptoms: Circulatory collapse, Headache, Loss of consciousness, Malaise, Tachycardia, SARS-CoV-2 test

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: AMITRIPTYLINE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Lactation decreased; Migraine
Allergies:
Diagnostic Lab Data: Test Date: 20210602; Test Name: COVID-19 virus test; Test Result: Negative ; Comments: No - Negative COVID-19 test
CDC 'Split Type': GBPFIZER INC2021657643

Write-up: headache; feeling unwell; passed out (collapse); passed out (collapse); Tachycardia; This is a spontaneous report from a contactable other healthcare professional received from the Medicines and Healthcare products Regulatory Agency (UK-MHRA). The regulatory authority report number is GB-MHRA-WEBCOVID-202106051921301090-OPVDJ Safety Report Unique Identifier GB-MHRA-ADR 25426351. A 34-year-old female patient received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on 03Jun2021 (Lot Number: Ew3143) as single dose for COVID-19 immunisation. Medical history included lactation decreased, and migraine. Unsure if patient had symptoms associated with COVID-19. Unsure if patient was enrolled in clinical trial. Patient was not pregnant. Patient was not currently breastfeeding. The patient''s concomitant medications included amtriptyline from 03Jun2021 for migraine. The patient experienced headache on an unspecified date, tachycardia on 04Jun2021. The patient feeling terrible she had tachycardia, headache, felling unwell and finally she passed out (collapse) on an unknown date. This case was reported as serious, serious criteria was hospitalization. The patient underwent lab tests and procedures which included COVID-19 virus test: negative on 02Jun2021. The outcome of events headache, feeling unwell and passed out (collapse) was unknown, tachycardia was not recovered. No follow-up attempts are possible. No further information is expected.

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