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VAERS Report 2157416

Case Report Section

Vaer Report Details

Age: 12 years old

Gender: Female

State: Outside US

Patient Died?
No
Vaccine information

Name: COVID19 (COVID19 (PFIZER-BIONTECH))

Type: Coronavirus 2019 vaccine

Manufacturer: PFIZER

Lot: ff8288


Date report was received
2022-03-04
Date form completed
Date Vaccinated
2021-10-20
Date of Onset
0
Number of days (onset date – vaccination date)
0
Adverse Event Description

allergic reaction similar to anaphylactic shock lasting about 3 hours. the vaccine, on the advice of the doctor, was administered in the clinic and the health personnel intervened promptly; allergic reaction similar to anaphylactic shock lasting about 3 hours. the vaccine, on the advice of the doctor, was administered in the clinic and the health personnel intervened promptly; this is a spontaneous report received from a contactable reporter(s) (consumer or other non hcp) from the regulatory authority-web. regulatory number: it-minisal02-846785. a 12 year-old female patient received bnt162b2 (comirnaty), intramuscular, administered in arm right, administration date 20oct2021 (lot number: ff8288) at the age of 12 years as dose 2, single for covid-19 immunisation. relevant medical history included: "allergy" (unspecified if ongoing), notes: allergy to various substances. the patient's concomitant medications were not reported. vaccination history included: covid-19 vaccine (dose 1, manufacturer unknown), for covid-19 immunization. the following information was reported: hypersensitivity (life threatening), anaphylactic shock (medically significant, life threatening) all with onset 20oct2021, outcome "recovered" and all described as "allergic reaction similar to anaphylactic shock lasting about 3 hours. the vaccine, on the advice of the doctor, was administered in the clinic and the health personnel intervened promptly". the patient underwent the following laboratory tests and procedures: impaired quality of life: 9/10. therapeutic measures were taken as a result of hypersensitivity, anaphylactic shock. reporter comment: allergy to various substances clinical course: actions taken (health personnel who administered life-saving drugs (intravenous cortisone) intervened).; reporter's comments: allergy to various substances

Lab Data
test name: impaired quality of life; result unstructured data: test result:9/10
List of symptoms
impaired quality of life hypersensitivity anaphylactic shock
Patient Died?
No
Date Died
NA
Birth defect
false
Vaccine Administered By:
Other
Vaccine Purchased By:
Unknown
Patient visit ER?
No
Patient Hospitalized?
No
Stay in hospital
No
Days in hospital
Unspecified
Permanent disability?
No
Allergies:
na
Current Illness
na