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This is VAERS ID 1416224

History of Changes from the VAERS Wayback Machine

First Appeared on 7/23/2021

VAERS ID: 1416224
VAERS Form:2
Age:73.0
Sex:Female
Location:Foreign
Vaccinated:2021-06-04
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 EX3617 / 1 - / -

Administered by: Other      Purchased by: ??
Symptoms: Anaphylactic reaction, Body temperature, Rash

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Coronary spastic angina; Food allergy
Allergies:
Diagnostic Lab Data: Test Date: 20210604; Test Name: body temperature; Result Unstructured Data: Test Result:36.3 Centigrade; Comments: before vaccination
CDC 'Split Type': JPPFIZER INC2021658655

Write-up: Anaphylaxis; body mild rash; This is a spontaneous report from a contactable physician received from the Regulatory Authority. The Regulatory authority report number is v21111935. The patient was a 73-year and 3-month-old female. Body temperature before vaccination was 36.3 degrees Centigrade. The patient had coronary spastic angina, mackerel allergy, and cocoa allergy. On 04Jun2021 at 15:00 (the day of vaccination), the patient received the first dose of BNT162B2 (COMIRNATY, Solution for injection, Lot number EX3617, Expiration date 31Aug2021) via an unspecified route of administration as a single dose for COVID-19 immunization. The course of the event was as follows: The event onset date was reported as 04Jun2021 15:15. On 04Jun2021 at 15:15 (the day of vaccination), 15 minutes after the vaccination, the patient experienced body mild rash. The patient did not have other abnormalities. On 04Jun2021 (the day of vaccination), the outcome of the event was recovered. The reporting physician classified the event as non-serious and assessed that the causality between the event and BNT162B2 as unassessable. The reporting physician commented as follows: Transfer to hospital. This report meets the criteria of Anaphylaxis.

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