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This is VAERS ID 1419920

History of Changes from the VAERS Wayback Machine

First Appeared on 6/25/2021

VAERS ID: 1419920
VAERS Form:2
Age:40.0
Sex:Male
Location:North Carolina
Vaccinated:2021-05-17
Onset:2021-06-04
Submitted:0000-00-00
Entered:2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / -

Administered by: Unknown      Purchased by: ??
Symptoms: Abdominal pain, Appendicitis, SARS-CoV-2 test

Life Threatening? Yes
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)? Yes
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: FISH OIL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Penicillin allergy (Penicillin as a child)
Allergies:
Diagnostic Lab Data: Test Date: 20210609; Test Name: covid-19 test; Test Result: Negative
CDC 'Split Type': USPFIZER INC2021701442

Write-up: diagnosed with appendicitis; abdominal pain; This is a spontaneous report from a contactable consumer (patient). A 40-year-old male patient received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection) via an unspecified route of administration, administered in right arm on 17May2021 at 14:15 (at age of 40 years old, Batch/Lot number was not reported) as a single dose for covid-19 immunization. Medical history included Penicillin allergy as a child. Concomitant medications included Daily Immunity Vitamin and fish oil. Prior to vaccination, the patient was not diagnosed with COVID-19. Starting around 04Jun2021, the patient started feeling abdominal pain. The pain slowly increased over the next few days. It became severe by 09Jun2021. He saw the primary care Dr in the morning of 09Jun2021. Dr sent he home with pain meds & ultrasound apt for the next day. The pain got so bad he went to ER 3:00 pm afternoon of 09Jun2021. At 10:30 pm on 09Jun2021, the patient was diagnosed with appendicitis. He had emergency appendectomy on morning of 10Jun2021. The events result in Doctor or other healthcare professional office/clinic visit and Emergency room/department or urgent care. Seriousness criteria reported as Life-threatening. The patient was hospitalized 2 days in Jun2021. The patient underwent lab tests and procedures which included covid-19 test: negative on 09Jun2021. The outcome of the events was recovering. Information about batch/lot number has been requested.


Record is removed as of 8/27/2021

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