Age: 71.0
Sex: M
Vaccine: COVID19
Symptoms: Asthenia, Body temperature, Chills, Headache, Insomnia
Clinical narrative: fever; real bad headache; chill/couldn't get warm s; weak; his arm really hurt where he got the shot; couldn't fall asleep; This is a spontaneous report from a contactable consumer (the patient).  A 71-year-old male patient received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot number: EL3302), via an unspecified route of administration, in the right arm on 23Feb2021 at 12:45 PM (at the age of 71-years) as a single dose for COVID-19 immunization.  Medical history included hypertension, cholesterol, abdominal discomfort. Concomitant medications included lisinopril taken for hypertension, simvastatin for blood cholesterol, omeprazole for abdominal discomfort, and multivitamin. Historic vaccination included first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot number: UNKNOWN), via an unspecified route of administration on 02Feb2021 (at the age of 71-years) as a single dose for COVID-19 immunization. On 24Feb2021, about 12 hours later almost to the hour, the patient had symptoms. The patient had fever, real bad headache, chills/couldn't get warm, weak, his arm really hurt where he got the shot, couldn't fall asleep. The patient clinical course was reported as follows: About 12 hours later almost to the hour, he had symptoms including: fever, real bad headache, chills, and the fever ran somewhere 100 or a little over he guesses. This lasted most of that morning on Wednesday on the 24Feb2021. He took his temperature with an oral digital thermometer. He reports his temperature usually ranges 97.7-97.6 somewhere around there. And he couldn't get warm. He had a mattress heater turned up and he felt weak and since he's by himself he has to get up to get water and he put his heavy robe on then he got back in bed. He never went to sleep, he couldn't fall asleep, his arm really hurt where he got the shot. There was a little ache with the first one but this one here really, really was bothering him. When he first got the second shot, he hates needles, it was a little sore and then when this started it really started to hurt and it was warm. That went on to the morning, then it started letting up a bit. His daughter came by and made him chicken soup and he felt a little better, still weakfish. His fever went down kind of far and he laid down the rest of the day. Towards dinner time or so he felt warm but didn't have fever, he went the opposite from being chilled to being warm but his temperature was around 98. Then later on he was taking some pain medicine, called his doctor and asked what he should take for the headache. Take whatever he has there is what he was told. Acetaminophen-aspirin/pain reliever/caffeine/pain reliever he thought he said it was 250 a pill. 250mg of aspirin 2 at one time by mouth. 65 mg of caffeine. Took 2 about every 5-6 hours. It says Headache relief, caller states he is just about blind, acetaminophen-aspirin/pain reliever/caffeine/pain reliever he thought he said it was 250 a pill. 250mg of aspirin 2 at one time by mouth. 65 mg of caffeine. Took 2 about every 5-6 hours. It got rid of whatever he had. Patient stated he needs to change the thingy on his magnifying system. Clarified he uses a magnifying system, it's a camera system with the 24 inch monitor. He felt better then he fell asleep around 10 that night and he woke up around 4:00AM on the 25Feb2021. He reports whatever fever he had, he was soaked but he felt really ok then from then on. He finally got up around 7-730 AM and he's feeling ok now. If he had a fever it broke. He reported it seems to be improved on the 25Feb2021. He was feeling pretty good he started making coffee so he didn't feel bad and he hasn't had anything since. He reports his arm is not bothering him unless he pokes it. It's the same thing with the flu shot, if he pushes on it in a certain place he knows he got the shot. The injection site is not warm, all that went away on 25Feb2021. The clinical outcome of fever, real bad headache, chills/ couldn't get warm, weak, couldn't fall asleep, was recovered on 25Feb2021. The clinical outcome of his arm really hurt where he got the shot was unknown.