Adverse Event Reporting

VAERS ID 904436
Gender Male
Age 47
StateCode NJ
Pharmaceutical Company PFIZER\BIONTECH
Lot Number
Number of vaccinations 1
Vaccinated 2020-12-17
Onset 2020-12-18
Condition Hospitalized Life Threatening
  • Pyrexia
  • Palpitations
  • Malaise
  • Hypotension
  • Tachycardia
  • Respiratory tract congestion
  • Chest X-ray abnormal
  • Activated partial thromboplastin time shortened
  • Alanine aminotransferase normal
  • Aspartate aminotransferase normal
  • Blood albumin normal
  • Blood alkaline phosphatase normal
  • Blood potassium decreased
  • Platelet count normal
  • Protein total normal
  • Blood creatinine normal
  • White blood cell count increased
  • Atrial fibrillation
  • Blood culture negative
  • Blood lactic acid decreased
  • Gram stain positive
  • Haematocrit decreased
  • International normalised ratio increased
  • Procalcitonin increased

Current Illness

Enterococcus faecalis UTI diagnosed 11/2520 associated with ureteral stent removal 11/10/20 treated successfully with Augmentin

Preexisting Conditions

Borderline HTN, recurrent renal calculi

Other Medications

Flomax 0.4mg Daily

Previous Vaccinations



Laboratory Data

Presentation labs: WBC 21.
6 Hct 38.
9 Plt 227 K 3.
3 Cr 1.
26 Lactate 2.
6 Protein 6.
5 Alb 3.
5 AST/ALT/AP normal INR 1.
4 PTT 48.
1 Procalcitonin 4.
7 CXR: Mild congestion Cultures Blod, urins (1day): NGTD


The patient was well prior to vaccination (12/17).
The day after, he felt mildly unwell and had a low grade fever.
The following day, he had a fever of 102.
He received 1L of fluid at Urgent Care and had a BP ion the 80s.
Shortly thereafter, he felt palpitations and developed AF.
He came to the hospital where he was tachycardia to 200 bpm and hypotensive to SBP70s.
He received aggressive fluid resuscitation (4L), IV metoprolol and was started on empiric Abx.
Within several hours, the HR lowered, BP increased, and AF spontaneously converted to sinus.
He had no dysuria.
Curtures so far have not shown growth at our hospital.
Urinary culture from urgent care has reportedly shows 20k gram positive cocci.