Report #2861858

Received Sep 27, 2025

Hospitalized

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Overview

Sex: Female
Age: 54 yrs
State: CA
Recovered: Unknown
Vaccinated: Sep 26, 2025
Onset: Sep 26, 2025
Days to onset: 0
Hospital days: —

Vaccines (4)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (PFIZER-BIONTECH))	PFIZER\BIONTECH	N/A	MY9550	IM / LA
PNC20	PNEUMO (PREVNAR20)	PFIZER\WYETH	N/A	MA2502	IM / RA
TDAP	TDAP (BOOSTRIX)	GLAXOSMITHKLINE BIOLOGICALS	N/A	94KG2	IM / LA
VARZOS	ZOSTER (SHINGRIX)	GLAXOSMITHKLINE BIOLOGICALS	UNK	3EG9B	IM / RA

Symptoms (5)

ChillsCoughDyspnoeaHeart rate decreasedNausea

Symptom narrative

Patient's relative called the pharmacy to inform us that the patient began to experience significant adverse effects 2 to 4 hours after vaccination. These effects included nausea, chills, cough, shortness of breath, and low heart rate. The patient was subsequently hospitalized. These were all the details provided at the time of communication.

Other medications

Metoprolol ER 50mg Tablet, Lidocaine 5% Patch, Baclofen 10mg Tablet, Naproxen 500mg

Allergies

No Known Allergy