VAERS ID: 1797267

AGE: 15| SEX: F|STATE: TX (United States)

Description

T1D; This is a spontaneous report from a contactable consumer. A 15-year-old female patient received bnt162b2 (PFIZER BIONTECH COVID-19 VACCINE), via an unspecified route of administration, administered in left arm on 12Jul2021 10:00 (Batch/Lot Number: EW0178) at the age of 15 years old as dose 2, single for COVID-19 immunisation. The patient's medical history was not reported. The patient has no known allergies. There were no concomitant medications (other medications in two weeks none). Historical vaccine included bnt162b2 (PFIZER BIONTECH COVID-19 VACCINE) received by the patient on 21Jun2021 10:00 (Batch/Lot Number: EW0167) administered in left arm as dose 1, single (at the age of 15 years old) for COVID-19 immunization. No other vaccine received in four weeks. The patient experienced T1D (Type 1 Diabetes Mellitus) on 16Aug2021 12:00. The patient was hospitalized for T1D for 3 days. Therapeutic measures were taken as a result of T1D which included insulin. The event resulted in Doctor or other healthcare professional office/clinic visit, Emergency room/department or urgent care, Hospitalization, Disability or permanent damage. The patient has no history of COVID-19 prior to vaccination. The patient has not been tested for COVID-19 post vaccination. Outcome of the event was recovered/resolved with sequelae (recovered with lasting effects).

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Symptoms

Type 1 diabetes mellitus

Vaccines

VAX DATE: 07-12-2021| ONSET DATE: 08-16-2021| DAYS TO ONSET: 35
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 2 COVID19 PFIZER\BIONTECH EW0178 LA

RECVDATE:10-19-2021
RPT_DATE:
CAGE_YR:
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:Y
HOSPDAYS:3
X_STAY:U
DISABLE:Y
RECOVD:N
LAB_DATA:
V_ADMINBY:PHM
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:USPFIZER INC202101310886
FORM_VERS:
TODAYS_DATE:10-16-2021
BIRTH_DEFECT:U
OFC_VISIT:Y
ER_ED_VISIT:Y
ALLERGIES:
V_FUNDBY:

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