VAERS ID: 902468

AGE: 59| SEX: M|STATE: (United States)

Description

Within 1 minute, patient complained of symptoms of lightheadedness, flushing, asked for water. Symptoms persisted, reported vagal and "spacey", vitals were 117/91, HR 67, O2 sat 99% on room air. Reported chest heaviness, shortness of breath and within 5 minutes developed rigors and urge to defecate. 911 called, repeat vital 150/89 HR 113 O2sat 97%, continues to want to defecate. 1 loose BM, transferred to ED

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Symptoms

Chills, Dizziness, Dyspnoea, Diarrhoea, Chest discomfort, Presyncope, Flushing, Feeling abnormal, Defaecation urgency

Vaccines

VAX DATE: 12-15-2020| ONSET DATE: 12-15-2020| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH EH9899 IM LA

RECVDATE:12-15-2020
RPT_DATE:
CAGE_YR:59
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:Trransferred to ED
V_ADMINBY:PVT
OTHER_MEDS:unknown
CUR_ILL:no
HISTORY:unknown
PRIOR_VAX:vaso-vagal type symptoms, similar presentation 12 hours post vaccine
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:12-15-2020
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:Y
ALLERGIES:unknown
V_FUNDBY:

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