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From the 11/19/2021 release of VAERS data:

This is VAERS ID 1680909

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Case Details

VAERS ID: 1680909 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-08-22
Onset:2021-08-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2782 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood creatine phosphokinase, Blood creatine phosphokinase MB, Blood pressure measurement, Body temperature, Bone pain, Chest discomfort, Chest pain, Dyskinesia, Feeling abnormal, Feeling cold, Gait disturbance, Headache, Heart rate, Hypoaesthesia, Muscular weakness, Myocarditis, Pyrexia, Troponin
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dyskinesia (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Osteonecrosis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210823; Test Name: CPK; Result Unstructured Data: Test Result:65; Test Date: 20210823; Test Name: CPK-MB; Result Unstructured Data: Test Result:6; Test Date: 20210823; Test Name: blood pressure; Result Unstructured Data: Test Result:99/75; Test Date: 20210822; Test Name: Body temperature; Result Unstructured Data: Test Result:36.3 Centigrade; Comments: before vaccination; Test Date: 20210822; Test Name: Body temperature; Result Unstructured Data: Test Result:37.3 Centigrade; Test Date: 20210823; Test Name: pulse; Result Unstructured Data: Test Result:74; Test Date: 20210823; Test Name: cardiac troponin; Result Unstructured Data: Test Result:No patellar tendon reflex increased or meningeal i; Comments: No patellar tendon reflex increased or meningeal irritation was observed today. Suspected myocarditis and submitted a test.
CDC Split Type: JPPFIZER INC202101098850

Write-up: Suspected myocarditis; chest pain; chest discomfort; feels poorly; headache; chilliness; pyrexia of 37.3 degrees Centigrade; could not grasp due to weakness of limbs; numbness of both lower extremities/hypoaesthesia on the back of both feet; movements involuntary of both lower limbs; bilateral anterior tibia pain/The pain in the entire tibia of both limbs did not improve and continued; difficulty in walking; This is a spontaneous report from a contactable other HCP received from the regulatory authority. Regulatory authority report number is v21124744. The patient was a 15-year and 7-month-old male. Body temperature before vaccination was 36.3 degrees Centigrade. The patient had no family history. The patient fell when the patient was receiving the influenza vaccine in childhood. On 22Aug2021 at 11:00 (the day of vaccination), the patient received the first dose of bnt162b2 (COMIRNATY, Solution for injection, Lot number FF2782, Expiration date 30Nov2021) via an unspecified route of administration as a single dose for COVID-19 immunization. On 22Aug2021 at 11:15 (15 minutes after the vaccination), the patient experienced headache, pyrexia, weakness of limbs, numbness of both lower extremities, bilateral anterior tibia pain, difficulty in walking, hypoaesthesia on the back of both feet, chest pain, chest discomfort. On 24Aug2021 (2 days after the vaccination), the outcome of the event was not recovered. The course of the event was as follows: Immediately after vaccination, symptoms (feels poorly, headache, chilliness, pyrexia of 37.3 degrees Centigrade, weakness of limbs, numbness of both lower extremities, movements involuntary of both lower limbs, bilateral anterior tibia pain) appeared. Although the patient complained at the vaccination institution, the patient was instructed to return home in a wheelchair with difficult in walking after staying in the rescue space for only one hour. The patient did not find a support hospital. The pain in the tibia of both limbs did not improve and continued. In addition, tibia pain continued during walking. At home, the patient could not grasp due to weakness of limbs, and although the patient managed to recover from yesterday to a state where the patient could walk, the pain on front of the tibia of both legs was not alleviated. In addition, the patient complained chest pain and chest discomfort today. Today (23Aug2021), blood pressure 99/75; pulse 74; CPK 65; CPK-MB 6 and there was no obvious increase, and heart rate was normal. Submitted outsourced examination of cardiac troponin. No patellar tendon reflex increased or meningeal irritation was observed today. Suspected myocarditis and submitted a test. The reporting other HCP classified the event as serious (risk of disability) and assessed that the causality between the event and bnt162b2 as unassessable. There are auspicious symptoms at the time of consultation, and there is a possibility of physical symptoms due to psychological factors, but a causality could not be ruled out. The reporting other HCP commented as follows: The patient went home with this symptom and the symptoms were not confirmed the next day. Based on the information conveyed to us, the local ambulance personnel have been informed that they will not refuse a request for dispatch in such cases. The reporter considered the response and judgment at the time of vaccination to be problematic. The reporter strongly requests an accurate judgment and response.


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