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