National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1416240

History of Changes from the VAERS Wayback Machine

First Appeared on 7/23/2021

VAERS ID: 1416240
VAERS Form:2
Age:55.0
Sex:Male
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 EY5420 / 2 - / -

Administered by: Other      Purchased by: ??
Symptoms: Blood pressure increased, Body temperature, Heart rate, Nausea, Pyrexia, Vomiting, Blood pressure measurement

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data: Test Date: 20210605; Test Name: Blood pressure; Result Unstructured Data: Test Result:130/80; Test Date: 20210603; Test Name: body temperature; Result Unstructured Data: Test Result:36.9 Centigrade; Comments: before vaccination; Test Date: 20210604; Test Name: body temperature; Result Unstructured Data: Test Result:37.5 Centigrade; Test Date: 20210605; Test Name: body temperature; Result Unstructured Data: Test Result:37.5 Centigrade; Test Date: 20210605; Test Name: Pulse rate; Result Unstructured Data: Test Result:88; Comments: beats/min
CDC 'Split Type': JPPFIZER INC2021659437

Write-up: blood pressure 130/80; Pyrexia 37.5 degrees centigrade; Vomiting; Queasy; This is a spontaneous report from a contactable nurse received from the Regulatory Authority. Regulatory authority report number is v21111928. The patient was a 55-year and 8-month-old male. Body temperature before vaccination was 36.9 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 14:00, the patient received the second dose of BNT162B2 (COMIRNATY, Solution for injection, Lot number EY5420, Expiration date 31Aug2021) via an unspecified route of administration as a single dose for COVID-19 immunization. On 04Jun2021 at 16:00, the patient experienced adverse events. The course of the event was as follows: On 04Jun2021 around 16:00 (1 day after the vaccination), the patient experienced Pyrexia 37.5 degrees centigrade, Queasy and Vomiting. On 05Jun2021 (2 days after the vaccination), the patient had Physician Office Visit. Pyrexia 37.5 degrees centigrade, pulse rate 88 beats/min, blood pressure 130/80. SOLDEM 3A 500ml 1 bottle; PP) CALONAL Prescription. On 04Jun2021 (1 day after the vaccination), the outcome of the event was not recovered. The reporting physician classified the event as non-serious and assessed that the event was related to BNT162B2. There was no other possible cause of the event such as any other diseases.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1416240&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166