VAERS ID: 1766576

AGE: 16| SEX: M|STATE: FR (Unknown)

Description

light headedness; BP: 82/-; Pallor facial; feeling cold; vagal reflex; Anaphylactic shock; This is a spontaneous report from a contactable physician received from the regulatory authority. Regulatory authority report number is v21127606. A 16-year-old male patient received bnt162b2 (COMIRNATY), dose 1 intramuscular, administered in left arm on 22Sep2021 16:55 (at the age of 16-year-old) (Batch/Lot Number: FJ7489; Expiration Date: 31Jan2022) as dose 1, single for covid-19 immunisation. The patient had no medical history and no family history. 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). The patient's concomitant medications were not reported. Body temperature before vaccination was 36.0 degrees centigrade. The course of the event was as follows: at 16:55, the vaccine was intramuscularly injected (on the patient's left shoulder) at his seat. The patient did not move after the vaccination. At 17:05, the patient experienced light headedness. Blood pressure (BP) was 82/-, pulse (P): 52, and SpO2: 97. Pallor facial and feeling cold that made his t-shirt wet appeared. When the patient's name was called, his response was clear. The patient's legs were elevated. A route for drip infusion was ensured with saline. BP: 90/-, P: 60, and SpO2: 97. Adrenaline 0.3 cc was intramuscularly injected (on the patient's right shoulder). At around 17:10, BP: 105/74, and P: 78. At 17:15, an ambulance was called. The patient's consciousness was clear all the time. The patient's condition was explained to his father. At 17:25, an ambulance arrived. BP: 119/80, P: 94, and SpO2: 98%. The patient was raced to a hospital and was hospitalized on an unspecified date due to the events. A possibility of anaphylactic shock was suspected. The reporting physician classified the event as non-serious and assessed that the event was related to bnt162b2. Other possible cause(s) of the event such as any other diseases was unknown. The reporter commented as follows: a possibility of vagal reflex also cannot be denied. However, the symptoms appeared while the patient was using his smartphone, and it was difficult to consider that possibility. Outcome of events was unknown.

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Symptoms

Dizziness, Pallor, Feeling cold, Presyncope, Anaphylactic shock, Blood pressure decreased, Heart rate, Oxygen saturation, Body temperature, Blood pressure measurement

Vaccines

VAX DATE: 09-22-2021| ONSET DATE: 09-22-2021| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH FJ7489 OT LA

RECVDATE:10-07-2021
RPT_DATE:
CAGE_YR:
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:Y
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:U
LAB_DATA:Test Date: 20210922; Test Name: BP; Result Unstructured Data: Test Result:82/-; Comments: 17:05; Test Date: 20210922; Test Name: BP; Result Unstructured Data: Test Result:90/-; Test Date: 20210922; Test Name: BP; Result Unstructured Data: Test Result:105/74; Comments: 17:10; Test Date: 20210922; Test Name: BP; Result Unstructured Data: Test Result:119/80; Comments: 17:25; Test Date: 20210922; Test Name: body temperature; Result Unstructured Data: Test Result:36.0 Centigrade; Comments: before vaccination; Test Date: 20210922; Test Name: P; Result Unstructured Data: Test Result:52; Comments: 17:05; Test Date: 20210922; Test Name: P; Result Unstructured Data: Test Result:60; Test Date: 20210922; Test Name: P; Result Unstructured Data: Test Result:78; Comments: 17:10; Test Date: 20210922; Test Name: P; Result Unstructured Data: Test Result:94; Comments: 17:25; Test Date: 20210922; Test Name: SPO2; Result Unstructured Data: Test Result:97; Comments: 17:05; Test Date: 20210922; Test Name: SPO2; Result Unstructured Data: Test Result:97; Test Date: 20210922; Test Name: SPO2; Result Unstructured Data: Test Result:98; Comments: 17:25
V_ADMINBY:OTH
OTHER_MEDS:
CUR_ILL:
HISTORY:Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
PRIOR_VAX:
SPLTTYPE:JPPFIZER INC202101260627
FORM_VERS:
TODAYS_DATE:10-06-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:Y
ALLERGIES:
V_FUNDBY:

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