VAERS ID: 1784294

AGE: 15| SEX: M|STATE: FR (Unknown)

Description

Anaphylaxis; This is a spontaneous report from a contactable physician received from the regulatory authority. Regulatory authority report number is v21128128. The patient was a 15-year and 6-month-old male. Body temperature before vaccination was 36.3 degrees centigrade. 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). On 18Sep2021 at 15:00 (the day of vaccination), the patient received the second dose of bnt162b2 (COMIRNATY solution of injection 0.3 ml, Lot number FH0151, Expiration date 31Dec2021) via an unspecified route of administration, at 0.3ml, as a single dose, at age of 15-year and 6-month-old of vaccination, for COVID-19 immunization. On 18Sep2021 at 15:08 (8 minutes after the vaccination), the patient experienced anaphylaxis. On 19Sep2021 (1 day after the vaccination), the outcome of the event was recovered. The course of the event was as follows: About 8 minutes after the vaccination, the patient experienced Pallor facial, Loss of consciousness (transient), blood pressure decreased to 70/40. Pulse 37 Spo2 98%. At 15:13 pm, the patient was given epipen, it was seemingly anaphylaxis. After that, blood pressure increased to 115/62, the patient could speak. There was mild redness on right upper arm. The patient had an emergency transport to the hospital from the vaccination venue. The patient was hospitalized in order to watch the progress. The patient took anti-allergic concentrate orally. The symptoms recovered on the next day noon and the patient discharged. The reporting physician classified the event as non-serious. The causality to the vaccine was not provided.

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Symptoms

Anaphylactic reaction, Heart rate, Oxygen saturation, Body temperature, Blood pressure measurement

Vaccines

VAX DATE: 09-18-2021| ONSET DATE: 09-18-2021| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 2 COVID19 PFIZER\BIONTECH FH0151

RECVDATE:10-14-2021
RPT_DATE:
CAGE_YR:
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:Y
HOSPDAYS:1
X_STAY:U
DISABLE:U
RECOVD:Y
LAB_DATA:Test Date: 20210918; Test Name: blood pressure; Result Unstructured Data: Test Result:70/40; Comments: 15:08; Test Date: 20210918; Test Name: blood pressure; Result Unstructured Data: Test Result:115/62; Comments: 15:13; Test Date: 20210918; Test Name: body temperature; Result Unstructured Data: Test Result:36.3 Centigrade; Comments: before vaccination; Test Date: 20210918; Test Name: pulse; Result Unstructured Data: Test Result:37; Comments: 15:08; Test Date: 20210918; Test Name: SPO2; Test Result: 98 %; Comments: 15:08
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 INC202101289509
FORM_VERS:
TODAYS_DATE:10-12-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:Y
ALLERGIES:
V_FUNDBY:

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