VAERS ID: 1773645

AGE: 16| SEX: F|STATE: NJ (United States)

Description

Developed appendicitis 14 days after first shot; This is a spontaneous report from a contactable consumer (patient). A 16-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE), via an unspecified route of administration, administered in arm left on 31Mar2021 16:00 (Batch/Lot Number: ER8737) (at the age of 16 years old) as dose 1, single for COVID-19 immunisation. The patient was not pregnant at the time of vaccination. Facility type vaccine was reported as Pharmacy or Drug Store. There were no known allergies and no other medical history. There were no other vaccine in four weeks and no other medications in two weeks. No COVID-19 prior vaccination. On 14Apr2021 00:00 (12:00 AM), the patient developed appendicitis 14 days after first shot. Event resulted in emergency room/department or urgent care, it was life threatening illness (immediate risk of death from the event). Treatment included appendectomy.The patient received BNT162B2 in left arm on 21Apr2021 16:00 (Lot number: ER8736) at dose 2.COVID-19 test post vaccination was Nasal Swab (PCR) on 21Jul2021 with negative result. The outcome of the event was recovered on unknown date.

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Symptoms

Appendicitis, SARS-CoV-2 test

Vaccines

VAX DATE: 03-31-2021| ONSET DATE: 04-14-2021| DAYS TO ONSET: 14
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH ER8737 LA

RECVDATE:10-09-2021
RPT_DATE:
CAGE_YR:
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:Y
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:Y
LAB_DATA:Test Date: 20210721; Test Name: Nasal Swab (PCR); Test Result: Negative
V_ADMINBY:PHM
OTHER_MEDS:
CUR_ILL:
HISTORY:Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
PRIOR_VAX:
SPLTTYPE:USPFIZER INC202101311486
FORM_VERS:
TODAYS_DATE:10-08-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:Y
ALLERGIES:
V_FUNDBY:

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