VAERS ID: 1803136

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

Description

Anaphylaxis; Breathing difficulty; Pallor facial; BP was 90/53; This is a spontaneous report from a contactable physician received from the Regulatory Agency (RA). Regulatory authority report number is v21128660. A 15-year and 6-month-old female patient received first dose of bnt162b2 (COMIRNATY) via unspecified route on 04Oct2021 18:05 (Lot Number: FJ5790; Expiration Date: 31Dec2021) single dose for covid-19 immunisation, at 15-year-old. No medical history. Body temperature before vaccination was 36.6 degrees Centigrade. The patient's concomitant medications were not reported. The patient experienced anaphylaxis, breathing difficulty, pallor facial, bp was 90/53 on 04Oct2021, 18:10, with outcome of recovered. The course of the event was as follows: Approximately 5 minutes after vaccination with the bnt162b2, breathing difficulty and pallor facial occurred. BP was 90/53, O2SAT was 97%. EPIPEN intramuscular injection, normal saline DIV started. After that, the symptoms improved. BP became 120/66. The reporting physician classified the event as non-serious and assessed that the causality between the event and bnt162b2 as unassessable. There was no other possible cause of the event such as any other diseases. The reporting physician commented as follows: Thought to be anaphylaxis.

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Symptoms

Dyspnoea, Pallor, Anaphylactic reaction, Blood pressure decreased, Oxygen saturation, Body temperature, Blood pressure measurement

Vaccines

VAX DATE: 10-04-2021| ONSET DATE: 10-04-2021| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH FJ5790

RECVDATE:10-21-2021
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: 20211004; Test Name: BP; Result Unstructured Data: Test Result:90/53; Test Date: 20211004; Test Name: BP; Result Unstructured Data: Test Result:120/66; Test Date: 20211004; Test Name: Body temperature; Result Unstructured Data: Test Result:36.6 Centigrade; Comments: before vaccination; Test Date: 20211004; Test Name: O2SAT; Test Result: 97 %
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 INC202101314147
FORM_VERS:
TODAYS_DATE:10-20-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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