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

This is VAERS ID 1443758



Case Details

VAERS ID: 1443758 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC8889 / 1 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Anaphylactic reaction, Blood pressure measurement, Depressed level of consciousness, Feeling hot, Hypotension, Nausea, Vision blurred
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210604; Test Name: Blood pressure; Result Unstructured Data: Test Result:95/60 mmHg; Comments: Min:95/60 mmHg; Test Date: 20210604; Test Name: Blood pressure; Result Unstructured Data: Test Result:120/80 mmHg; Comments: Max:120/80 mmHg
CDC Split Type: DKPFIZER INC2021688085

Write-up: Anaphylaxis; Started with blurred vision; Started with feeling of warmth; Nausea; Hypotension, continuingly decreasing blood pressure after treatment with alnok, tavegyl and solumedrol.; Decreased level of consciousness; This is a spontaneous report from a contactable physician downloaded from the Regulatory Authority (RA), regulatory authority number DK-DKMA-WBS-0070474. A 17-years-old female patient received bnt162b2 (COMIRNATY, formulation: Solution for injection, Batch/Lot Number: FC8889) intramuscular on 04Jun2021 (at the age of 17-years-old) as dose 1, single for covid-19 immunisation. The patient medical history and concomitant medications were not reported. On 04Jun2021, 10 minutes after the vaccination, the patient experienced anaphylaxis (lasted for 4 hours), blurred vision, feeling of warmth, nausea, hypotension and depressed level of consciousness. The adverse drug reactions were by the reporter reported as resulting in hospitalisation on 04Jun2021. The patient was treated with Alnok (CETIRIZINE) as oral treatment and with Solu-medrol (Methylprednisolone Sodium Succinate) and Tavegyl (Clemastine) as intramuscular injections. The patient underwent lab tests and procedures which included Blood pressure, minimum 95/60 mmHg and maximum 120/80 mmHg on 04Jun2021. Brighton scale criteria was time onset first reaction 10 min. acute reaction was yes, rapid progression was yes, duration of reaction 4hr. No skin and mucous membrane symptoms. No airway symptoms. Cardiovascular symptoms included hypotension, decreased level of consciousness, not included tachycardia, capillary refill time greater than 3 s (second), reduced central pulse volume, loss of consciousness. Gastrointestinal symptoms included nausea and not included vomiting, diarrhoea, abdominal pain blood pressure was minimun 95/60 and maximum 120/80 S-tryptase, acute as no value. S-tryptase, base as no value. The patient was hospitalised in response to all events and all events were considered as medically significant. Temperature maximum no value. Outcome of all events was recovered on 04Jun2021. No follow-up attempts possible. No further information expected.


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