Age: 78.0
Sex: M
Vaccine: COVID19
Symptoms: Magnetic resonance imaging, Oral mucosal blistering, Oropharyngeal blistering, Oropharyngeal pain
Clinical narrative: can't close right eye; Severe case of Bells Palsy; Right side face dropped; can't swallow; blisters in the mouth and throat on one side; blisters in the mouth and throat on one side; severe headache for a month; sore throat; right ear ache/severe pain in right ear; cough; dizzy; This is a spontaneous report received from a contactable reporter(s) (Consumer or other non HCP). The reporter is the patient.  A 79 year-old male patient received bnt162b2 (BNT162B2), administered in arm, administration date 04Feb2021 (Batch/Lot number: unknown) at the age of 78 years as dose 2, single for covid-19 immunisation. Relevant medical history included: "diabetic", start date: 2013 (unspecified if ongoing), notes: Pertinent details: under control now last A/C 6.0, highest A/C 12.6 in 2018; "Open heart surgery", start date: 1996 (unspecified if ongoing), notes: Pertinent details: 20Sep2002; "Kidney stone", start date: 1970 (unspecified if ongoing), notes: Pertinent details: Lithotripsy; 06Feb2021, 10Sep2021; "Back issues", start date: 2000 (unspecified if ongoing), notes: Pertinent details: spondylosis L5-S1, (illegible)- anterolisthesis; "lithotripsy", start date: 06Feb2012 (unspecified if ongoing), notes: Pertinent details: Lithotripsy; 06Feb2012, 10Sep2018. There were no concomitant medications. Vaccination history included: Bnt162b2 (Dose: 1st , Time: 02:15 PM, Anatomical site of injection: arm, Patient Route of Administration: Intramuscular), administration date: 12Jan2021, when the patient was 78 years old, for Covid-19 Immunization, reaction(s): "Headache", "Cough", "Sore Throat", "Ear Pain", "Blister in mouth"; Bnt162b2 (Dose: 1st , Time: 02:15 PM, Anatomical site of injection: arm, Patient Route of Administration: Intramuscular), administration date: 12Jan2021, when the patient was 78 years old, for Covid-19 immunization, reaction(s): "Bell's palsy". The following information was reported: BELL'S PALSY (disability, medically significant) with onset 18Feb2021, outcome "recovering", described as "Severe case of Bell's Palsy"; OROPHARYNGEAL BLISTERING (medically significant), ORAL MUCOSAL BLISTERING (medically significant) all with onset 08Feb2021, outcome "unknown" and all described as "blisters in the mouth and throat on one side"; FACIAL PARALYSIS (medically significant) with onset 13Feb2021, outcome "unknown", described as "Right side face dropped"; HEADACHE (non-serious) with onset 2021, outcome "unknown", described as "severe headache for a month"; OROPHARYNGEAL PAIN (non-serious) with onset 2021, outcome "unknown", described as "sore throat"; EAR PAIN (non-serious) with onset 2021, outcome "unknown", described as "right ear ache/severe pain in right ear"; COUGH (non-serious) with onset 2021, outcome "unknown", described as "cough"; DIZZINESS (non-serious) with onset 2021, outcome "unknown", described as "dizzy"; DYSPHAGIA (non-serious) with onset 11Feb2021, outcome "unknown", described as "can't swallow"; EYE DISORDER (non-serious) with onset 18Mar2021, outcome "unknown", described as "can't close right eye". The events "severe case of bells palsy", "blisters in the mouth and throat on one side", "blisters in the mouth and throat on one side", "right side face dropped", "severe headache for a month", "sore throat", "right ear ache/severe pain in right ear", "cough", "dizzy", "can't swallow" and "can't close right eye" were evaluated at the physician office visit. The patient underwent the following laboratory tests and procedures: glycosylated haemoglobin: (unspecified date) 6.0; (2018) 12.6; investigation: (16Sep2021) normal, notes: for containing dizzy; magnetic resonance imaging: (11Jun2021) bell's palsy + small strode. Therapeutic measures were taken as a result of bell's palsy which included Valtrex, prednisone, medizirie, Zofran and MAI. Clinical course: Shots taken 12Jan2021 and 04Feb2021. On 02Feb2021, severe pain in right ear. On 08Feb2021, physician noted sick blisters in month on one side. On 11Feb2021, sick Dizzy pain & blister, can't swallow. On 13Feb2021, right side face dropped. On 18Feb2021, full Bell's palsy - given Valtrex, Prednisolone, Meclizine, Zofran. On 25Feb2021, another round of Valtrex + Prednisolone. On 18Mar2021, eye physician reported - can't close right eye. On 29Mar2021, physician recommended going to ENT. On 28May2021, ENT ordered MRI. On 11Jun2021, MRI - confirmed Bell's palsy + small strode. On 16Sep2021 ENT - VNG test for containing dizzy. Systems' right ear pain, blisters right side of my mouth, throat, cannot swallow, severe headache for over a month, dizzy and cough.  The lot number for bnt162b2 was not provided and will be requested during follow up.