Adverse Event Reporting

VAERS ID 904385
Gender Female
Age 83
StateCode TX
Pharmaceutical Company PFIZER\BIONTECH
Lot Number
Number of vaccinations 1
Vaccinated 2020-12-16
Onset 2020-12-16
Condition Hospitalized Permanent Disability
  • Loss of consciousness
  • Tenderness
  • Comminuted fracture
  • Epistaxis
  • Facial bones fracture
  • Haemorrhage
  • Subcutaneous haematoma

Current Illness


Preexisting Conditions

Sjogrens Syndrome, Hypertension, Hypothyroidism

Other Medications

amLODIPine, 7.5 mg, oral, Nightly ? cevimeline, 30 mg, oral, TID ? cholecalciferol (vitamin D3), 2,000 Units, oral, Daily ? irbesartan-hydrochlorothiazide, 1 tablet, oral, QAM ? levothyroxine, 50 mcg, oral, Daily at 0600 ? metoprolol s

Previous Vaccinations


Quinilones, Sulfa

Laboratory Data

There is a comminuted fracture of the nasal bones bilaterally with Left orbital floor blowout fracture with hemorrhagic opacification of the left maxillary sinus and slight inferior displacement with slight extraconal fat protrusion.
There is associated left orbital preseptal and postseptal emphysema.
Comminuted fracture involving the anterior and posterior wall of the left maxillary sinus with hemorrhagic opacification of the sinus and left malar subcutaneous hematoma


Patient is a pleasant 83 y.
female pediatrician with history of Sjogren's, hypothyroidism, hyperlipidemia, hypertension who had been at Hospital to get her Covid vaccine.
30 minutes after doing so she reports being in the lobby and about to walk upstairs and feeling fine.
The next thing she knows she wakes up on the stairs with her nose and face bleeding surrounded by healthcare team.
She denies any precipitating symptoms such as chest pain, shortness of breath, fevers dizziness, headache.
She reports feeling well otherwise in the last few days.
I did a thorough bony palpation exam including spine and he only point of tenderness besides on her face was the area above her right ankle.
She does not have a history of syncope or collapse