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VAERS ID: 1000264

AGE: 40| SEX: F|State: FR

Description

This is a spontaneous report from two contactable physicians, A 40-year-old female patient received the 1st dose of vaccine expiration date: 30Apr2021, intramuscular on 06Jan2021 at single dose for covid-19 immunisation. The patient medical history included anaphylaxis after IV penicillin according to the patient from an unknown date and not ongoing, ongoing shoulder pain chronic. The patient's concomitant medications included levonorgestrel (KYLEENA) from 29Oct2018 to an unknown date for contraception, paracetamol (PANODIL) for pain, gabapentin form 15Dec2020 for pain. The patient experienced anaphylactic reaction (patient was responsive the entire time) 30 minutes after vaccination, dry cough, flushing of neck and tachycardia; all on 06Jan2021. dry cough, flushing and tachycardia. All events were reported as life-threatening resulting hospitalization from 06Jan2021 to 07Jan2021. The patient underwent lab tests and procedures which included the result of tryptase: unknown, pulse rate: 83 bpm, blood pressure: 160/90 mmHg, oxygen saturation: 99%; all on 06Jan2021. The patient was treated with EPINEPHRINE, 2ml IV tavegyl (CLEMASTINE) and nasal oxygen. At the hospital she was treated with Solu-medrol (Methylprednisolone Sodium Succinate) and was sent home with prednisolone (25mg) and antihistamine for 3 days. Outcome of anaphylactic reaction, dry cough, flushing and tachycardia was recovered on 06Jan2021. Follow-up (29Jan2021): new information downloaded,(dry cough, flushing of neck and tachycardia).

Symptoms

Anaphylactic reaction, Oxygen saturation, Blood pressure measurement, Tachycardia, Cough, Tryptase, Flushing, Heart rate

Vaccines

VAX DATE: 05 January 2021 | ONSET DATE: 05 January 2021 | DAYS TO ONSET: 0
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • PFIZERBIONTECH
  • COVID19 (COVID19 (PFIZER-BIONTECH))
  • 1
  • OT
  • EM0477

RECVDATE:
03 February 2021
CAGE_YR:
CAGE_MO:
RPT_DATE:
DIED:
DATEDIED:
L_THREAT:
Y
ER_VISIT:
HOSPITAL:
Y
HOSPDAYS:
1
X_STAY:
DISABLE:
RECOVD:
Y
LAB_DATA:
Test Date: 20210106; Test Name: Blood pressure; Result Unstructured Data: Test Result:160/90 mmHg; Test Date: 20210106; Test Name: pulse rate; Result Unstructured Data: Test Result:83 beats/min; Test Date: 20210106; Test Name: Oxygen saturation; Test Result: 99 %; Test Date: 20210106; Test Name: Tryptase; Result Unstructured Data: Test Result:Unknown results
V_ADMINBY:
OTH
OTHER_MEDS:
KYLEENA; PANODIL; GABAPENTIN
CUR_ILL:
Shoulder pain (Chronic)
HISTORY:
Medical History/Concurrent Conditions: Anaphylactic reaction to drug
PRIOR_VAX:
SPLTTYPE:
DKPFIZER INC2021043337
FORM_VERS:
2
TODAYS_DATE:
01 February 2021
BIRTH_DEFECT:
OFC_VISIT:
ER_ED_VISIT:
ALLERGIES:
V_FUNDBY:
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