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This is VAERS ID 912067

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/7/2021

VAERS ID: 912067
VAERS Form:2
Age:
Sex:Female
Location:New Mexico
Vaccinated:2020-12-01
Onset:2020-12-01
Submitted:0000-00-00
Entered:2020-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Anaphylactic reaction

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USPFIZER INC2020511009

Write-up: patient''s anaphylactic reaction persisted longer than expected; This is a spontaneous report from a contactable pharmacist. A 45-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE), via an unspecified route of administration in Dec2020 at a single dose for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. The patient''s anaphylactic reaction persisted longer than expected in Dec2020. The outcome of the event was unknown. The batch/lot number for the vaccine, BNT162B2, was not provided and will be requested during follow-up.; Sender''s Comments: The causal relationship between BNT162B2 and the event anaphylactic reaction cannot be excluded as the information available in this report is limited and does not allow a medically meaningful assessment. This case will be reassessed once additional information becomes available. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees, and Investigators, as appropriate.


Changed on 5/7/2021

VAERS ID: 912067 Before After
VAERS Form:2
Age:
Sex:Female
Location:New Mexico
Vaccinated:2020-12-01
Onset:2020-12-01
Submitted:0000-00-00
Entered:2020-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Anaphylactic reaction

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USPFIZER INC2020511009

Write-up: patient''s anaphylactic reaction persisted longer than expected; This is a spontaneous report from a contactable pharmacist. A 45-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE), via an unspecified route of administration in Dec2020 at a single dose for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. The patient''s anaphylactic reaction persisted longer than expected in Dec2020. The outcome of the event was unknown. The batch/lot number for the vaccine, BNT162B2, was not provided and will be requested during follow-up.; Sender''s Comments: The causal relationship between BNT162B2 and the event anaphylactic reaction cannot be excluded as the information available in this report is limited and does not allow a medically meaningful assessment. This case will be reassessed once additional information becomes available. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees, and Investigators, as appropriate.


Changed on 5/14/2021

VAERS ID: 912067 Before After
VAERS Form:2
Age:
Sex:Female
Location:New Mexico
Vaccinated:2020-12-01
Onset:2020-12-01
Submitted:0000-00-00
Entered:2020-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Anaphylactic reaction

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USPFIZER INC2020511009

Write-up: patient''s anaphylactic reaction persisted longer than expected; This is a spontaneous report from a contactable pharmacist. A 45-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE), via an unspecified route of administration in Dec2020 at a single dose for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. The patient''s anaphylactic reaction persisted longer than expected in Dec2020. The outcome of the event was unknown. The batch/lot number for the vaccine, BNT162B2, was not provided and will be requested during follow-up.; Sender''s Comments: The causal relationship between BNT162B2 and the event anaphylactic reaction cannot be excluded as the information available in this report is limited and does not allow a medically meaningful assessment. This case will be reassessed once additional information becomes available. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees, and Investigators, as appropriate.

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