VAERS ID: 1751428

AGE: 12| SEX: M|STATE: FR (Unknown)

Description

clonic convulsion; consciousness disturbed; Convulsion; JCS 10; encephalopathy; CK: 866; This is a spontaneous report from a contactable healthcare professional received from the regulatory authority. Regulatory authority report number is v21127173. A 12-year and 9-month-old male patient received BNT162B2 (COMIRNATY, Solution for injection Lot number FE8162, Expiration date 30Nov2021), via an unspecified route of administration on 12Sep2021 at 10:00 as dose 2, single (at the age of 12 years old) for COVID-19 immunisation. The patient's medical history and concomitant medications were not reported. 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) was unknown as the patient did not receive the vaccination at the hospital. On 13Sep2021 at 06:00 (1 day after the vaccination), the patient experienced convulsion, consciousness disturbed and encephalitis/encephalopathy. On 13Sep2021 (1 day after the vaccination), the patient was admitted to the hospital and on 15Sep2021 (3 days after the vaccination), the patient was discharged from hospital. The course of the event was as follows: At 06:00 on 13Sep2021, clonic convulsion appeared for two minutes, and the patient was move to the hospital by ambulance. As JCS 10 continued, the patient was admitted to the hospital for investigation and treatment. CK: 866, T-Bil: 5.0, D-Bil: 0.3 and Lactate: 49. There were no other abnormalities founded in blood test. There were also no abnormalities on CT or cerebrospinal fluid test. The patient was diagnosed with encephalopathy, and steroid pulse was performed. From the night on 13Sep2021, the patient woke up, and condition turned to normal. On 15Sep2021 (3 days after the vaccination), the outcome of the events was recovered. The reporting other HCP classified the event as serious (Hospitalized) and assessed that the event was related to bnt162b2. There was no other possible cause of the event such as any other diseases.

Open in Wayback Machine
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Symptoms

Blood creatine phosphokinase increased, Encephalopathy, Depressed level of consciousness, Blood test, Computerised tomogram, CSF test, Altered state of consciousness, Blood creatine phosphokinase, Blood bilirubin, Blood lactic acid, Clonic convulsion, Bilirubin conjugated, Coma scale, Seizure

Vaccines

VAX DATE: 09-12-2021| ONSET DATE: 09-13-2021| DAYS TO ONSET: 1
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 2 COVID19 PFIZER\BIONTECH FE8162

RECVDATE:10-01-2021
RPT_DATE:
CAGE_YR:
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:Y
HOSPDAYS:2
X_STAY:U
DISABLE:U
RECOVD:Y
LAB_DATA:Test Date: 20210917; Test Name: D-Bil; Result Unstructured Data: Test Result:0.3; Test Date: 20210917; Test Name: T-Bil; Result Unstructured Data: Test Result:5.0; Test Date: 20210917; Test Name: CK; Result Unstructured Data: Test Result:866; Test Date: 20210917; Test Name: Lactate; Result Unstructured Data: Test Result:49; Test Date: 20210917; Test Name: blood test; Result Unstructured Data: Test Result:no other abnormalities; Test Date: 20210917; Test Name: JCS; Result Unstructured Data: Test Result:10; Test Date: 20210917; Test Name: CT; Result Unstructured Data: Test Result:no abnormalities; Test Date: 20210917; Test Name: cerebrospinal fluid test; Result Unstructured Data: Test Result:no abnormalities
V_ADMINBY:OTH
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:JPPFIZER INC202101227851
FORM_VERS:
TODAYS_DATE:09-30-2021
BIRTH_DEFECT:U
OFC_VISIT:Y
ER_ED_VISIT:Y
ALLERGIES:
V_FUNDBY:

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