National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 11/19/2021 release of VAERS data:

This is VAERS ID 1721147

Government Disclaimer on use of this data



Case Details

VAERS ID: 1721147 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE8162 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure measurement, Body temperature, Heart rate, Heart rate decreased, Hypersensitivity, Loss of consciousness, Oxygen saturation, Presyncope
SMQs:, Torsade de pointes/QT prolongation (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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? 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: 20210904; Test Name: blood pressure; Result Unstructured Data: Test Result:90/60; Test Date: 20210904; Test Name: blood pressure; Result Unstructured Data: Test Result:98/60; Test Date: 20210904; Test Name: body temperature; Result Unstructured Data: Test Result:36.2 Centigrade; Comments: Before vaccination; Test Date: 20210904; Test Name: pulse rate; Result Unstructured Data: Test Result:56; Test Date: 20210904; Test Name: pulse rate; Result Unstructured Data: Test Result:60; Test Date: 20210904; Test Name: oxygen saturation; Result Unstructured Data: Test Result:99
CDC Split Type: JPPFIZER INC202101163963

Write-up: Loss of consciousness; Pulse rate was 56; it could be considered as Acute allergic reaction occurring; It could be considered to be Vasovagal reflex; This is a spontaneous report from a contactable physician received from the Regulatory Authority. (Regulatory Authority report number: v21125953). The patient was a 42-year-old female. The patient''s body temperature on 04Sep2021 (before vaccination) was 36.2 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 04Sep2021 at 11:30 (the day of vaccination), the patient received the first dose of BNT162B2 (COMIRNATY, Solution for injection, Lot number: FE8162, Expiration date: 30Nov2021) as dose 1, single, with route of administration unspecified, for COVID-19 immunization. The onset date of the events was reported as 04Sep2021 at 11:40 (10 minutes after the first dose of vaccination). On 04Sep2021 (the day of vaccination), the outcome of the events was recovered. The course of the event was as follows: On 04Sep2021 at 11:40 (10 minutes after the vaccination), the patient experienced loss of consciousness; blood pressure was 90/60; pulse rate was 56; oxygen saturation was 99, and it could be considered as acute allergic reaction occurring. The patient''s consciousness recovered immediately, and conversation also became possible. The patient rested for a while, and blood pressure was 98/60, pulse rate was 60, and it was not considered to be dyspnoea or cyanosis. It could be considered as vasovagal reflex. The patient went home on foot after resting (about 30 minutes). The reporting physician classified the events as non-serious and assessed that the events were related to BNT162B2. No follow-up attempts are needed. No further information is expected.


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1721147


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