VAERS ID: 1819693

AGE: 14| SEX: M|STATE: FR (Unknown)

Description

Consciousness disturbed; Dizziness; Fall down; physical deconditioning; This is a spontaneous report from a contactable physician received from the Regulatory Agency (RA). Regulatory authority report number is v21129128. The patient was a 14-year and 9-month-old male (age at the vaccination). Body temperature before vaccination was 36.5 degrees Centigrade on 03Oct2021. The patient's concomitant medications were not reported. 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 03Oct2021 (the day of the vaccination), the patient received the first dose of bnt162b2(COMIRNATY, Lot number FH3023, Expiration date 31Dec2021) via an unspecified route of administration as a single dose for COVID-19 immunization. On 05Oct2021 at 09:50 (2days after the vaccination), the patient experienced Consciousness disturbed. On 05Oct2021 (2 days after the vaccination), the patient was admitted to the hospital and discharged on 06Oct2021. On 06Oct2021 (3 days after the vaccination), the outcome of the event was recovering. Clinical source: Coronavirus vaccination was provided on 03Oct2021. On 04Oct2021, the patient experienced physical deconditioning. Since the symptoms had subsided by the morning on 05Oct2021, the patient went to school. However, the patient recognized dizziness and fell down. As consciousness disturbed was also noted, the patient was emergently transferred to the hospital by an ambulance. Head CT, electroencephalography, and electrocardiography showed no abnormal. A possibility of organic disease was considered unlikely, and association with COMIRNATY vaccination was suggested. The condition had improved by 06Oct2021, and the patient was discharged. The reporting physician classified the event as serious(caused hospitalization from 05Oct2021 to 06Oct2021 ) and assessed the causality between the event and bnt162b2 as un-assessable. There was no other possible cause of the event such as any other diseases.

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Symptoms

Dizziness, Electroencephalogram, Electrocardiogram, Fall, Computerised tomogram head, Body temperature, Altered state of consciousness, Physical deconditioning

Vaccines

VAX DATE: 10-03-2021| ONSET DATE: 10-04-2021| DAYS TO ONSET: 1
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH FH3023

RECVDATE:10-27-2021
RPT_DATE:
CAGE_YR:
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:Y
HOSPDAYS:1
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:Test Date: 20211003; Test Name: body temperature; Result Unstructured Data: Test Result:36.5 Centigrade; Comments: Before vaccination.; Test Date: 20211005; Test Name: Head CT; Result Unstructured Data: Test Result:no abnormal; Test Date: 20211005; Test Name: electrocardiography; Result Unstructured Data: Test Result:no abnormal; Test Date: 20211005; Test Name: electroencephalography; Result Unstructured Data: Test Result:no abnormal
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 INC202101353184
FORM_VERS:
TODAYS_DATE:10-26-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:Y
ALLERGIES:
V_FUNDBY:

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