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

This is VAERS ID 1416227



Case Details

VAERS ID: 1416227 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA5829 / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Dehydration, Gait disturbance, Hypophagia, Stress, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? 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:36.6 Centigrade; Comments: before vaccination
CDC Split Type: JPPFIZER INC2021658871

Write-up: stress; Vomiting; poor oral intake; Difficulty in walking; Dehydration; This is a spontaneous report from a contactable physician received from the Regulatory Authority. Regulatory authority report number is v21111912. A 80-year-old female patient received the second dose of BNT162B2 (COMIRNATY; lot number: FA5829; expiry: 31Aug2021), via an unspecified route of administration on 03Jun2021 14:30 (at the age of 80-years-old) as 2nd dose, single for COVID-19 immunisation. The patient''s medical history and concomitant medications were not reported. The patient had no family history. 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). The patient''s body temperature before vaccination was 36.6 degrees Centigrade. On 03Jun2021 at 14:30 (the day of vaccination), the patient received the second dose of BNT162B2. On 04Jun2021 at 07:00, the patient experienced Dehydration, Vomiting and Difficulty in walking. On 05Jun2021, the outcome of the events was recovered. The course of the event was as follows: At 14:30 on 03Jun2021, the patient was vaccinated. From the morning of 04Jun2021 07:00, vomiting began to appear, and poor oral intake. The patient had no symptom of pyrexia and had symptom of Difficulty in walking. The patient was transported to a hospital via GA (gurney and ambulance). Diagnosed as Dehydration, after treatment, the patient recovered and went home on the same day. The reporting physician classified the event as non-serious and the causality between the event and BNT162B2 as unassessable. There was no other possible cause of the event such as any other diseases. The reporting physician commented as follows: The patient has symptoms of vomiting and dehydration due to stress. The outcome of stress was unknown; while for the other events was recovered on 05Jun2021.


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