Adverse Event Reporting

VAERS ID 922015
Gender Male
Age 18
StateCode WY
Pharmaceutical Company PFIZER\BIONTECH
Lot Number 122120V1
Number of vaccinations 1
Vaccinated 2020-12-31
Onset 2021-01-05
Condition Permanent Disability
  • Asthenia
  • Blood glucose normal
  • Mobility decreased
  • Fall
  • Blood chloride normal
  • Blood potassium decreased
  • Blood sodium normal
  • Haematocrit normal
  • Haemoglobin normal
  • Mean cell haemoglobin normal
  • Mean cell volume normal
  • Platelet count normal
  • Dysstasia
  • Muscular weakness
  • Blood creatinine normal
  • Carbon dioxide normal
  • Red blood cell sedimentation rate normal
  • Blood urea decreased
  • Full blood count abnormal
  • Aspartate aminotransferase increased
  • Drug screen
  • Leukocytosis
  • Areflexia
  • Differential white blood cell count abnormal
  • Rheumatoid factor
  • Shift to the left

Current Illness


Preexisting Conditions


Other Medications


Previous Vaccinations



Laboratory Data

1/5/21 blood work: CBC shows leukocytosis with mild left shift no lymphocytosis H&H Nl, ratio MCV, MCH Nl, plts nl, .
CMP: Na:141, Cl:104, BUN:9, K:3.
3, CO2:26.
2, Cr:1, Glu:107.
AST:196 (H) AST:354 (H).
Urine drug screen, RF are pending.
ESR 12 (wnl)


Pt describes falling with onset of weakness below the hip level about 6 inches above the patella with missing clonus reflex.
The pt cannot squat down with associated observable loss of strength, pt is not able to stand up.
The pt has fallen 7 times since symptom onset around lunchtime between 1200 and 1300.
Pt denies LOC.