Age: 67.0
Sex: M
Vaccine: COVID19
Symptoms: Chest discomfort, Dyspnoea, Pain in extremity
Clinical narrative: Shortness of breath/ Trouble breathing; Tightness in chest; I did have soreness in my left arm; This is a spontaneous report from a contactable consumer (patient). A 67-years-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE; Solution for injection; Lot Number: ER8734; Expiration Date: 31Jul2021), via an unspecified route of administration, administered in arm left on 05May2021  (at the age of 67-years-old) as dose 1, single for COVID-19 immunisation. Medical history included heart attack from 2004 to an unknown date (had first heart attack in 2004, see a cardiologist regularly, every 4 month), heart disease (diagnosis date: stated as 17 years ago), blood pressure high, cholesterol, blockage in arteries, frequent urination and enlarged prostate. Concomitant medications included lisinopril taken for hypertension from 2004 to an unspecified stop date; isosorbide taken for hypertension from 2004 and ongoing; ticagrelor (BRILINTA) taken for an unspecified indication as blood thinner; rosuvastatin calcium (CRESTOR) taken for blood cholesterol, finasteride. The patient stated that he was taking Crestor because he had heart surgery in 2004 and had blockage in arteries, that was why he was taking cholesterol medication. Patient also took two other medications for frequent urination and visit urologist because patient frequently urinate large and had an enlarged prostate. On 06May2021 morning when the patient got out of the bed, he experienced shortness of breath/trouble breathing, tightness in chest and "I did have soreness in my left arm". The patient received the first COVID vaccine injection on 05May2021 night at his pharmacy. The patient called as he was having side effects. The patient was having shortness of breath, trouble breathing and tightness in my chest and he already have other illness like ongoing heart disease, really he did not think it was going to work out for him. On 06May2021, he saw his primary doctor and he told him that he had been having the breathing problems like shortness of breath and tightness in his chest, so he scheduled him for (incomplete sentence). The doctor was going to see him back in a week and told the patient to call him right away if he could get worse. The patient was schedule for the second dose on 26May2021 at 15:00 but right now it looks like the symptoms persist and he would not be able to get the second injection. If it going to cause him problem, he already have heart diseases and that could just going to cause him more problem. The patient had soreness in his left arm where he got the injection but that was not too bad that was okay. He could deal with the soreness. The patient stated that he could not have a heart attack or something. In another words, he was at high risk. He heard good things about Pfizer and Moderna but he don't think it was going to work out for him. He already had heart disease and then it causing him to have tightness in his chest and shortness of breath which was not good. The patient did not receive any treatment for the events. The primary doctor told him that if he started the problems still, he was going to give him a call. If the symptoms don't go, get worse, the symptoms right now that he was having tightness and the problems breathing was the same, it was from the morning. It had not worse. He could feel the tightness in his chest, right now he think like for him talking with them he have to get another breath. The patient further reported that if he don't get better then he would just call his doctor and the doctor could schedule an appointment for him for next Thursday. The patient asked if he decide not to take, not to continue with the second shot then did he have to notify again the Pfizer. The outcome of the event soreness in my arm was unknown and was not resolved for the rest of the events.  No follow-up attempts are needed. No further information is expected.