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VAERS Report 2156604

Case Report Section

Détails du rapport Vaer

Âge: N/A

Genre: Male

Région : Outside US

Patient décédé?
Non
Renseignements sur les vaccins

Nom: COVID19 (COVID19 (PFIZER-BIONTECH))

Type : Coronavirus 2019 vaccine

Fabricant: PFIZER

Lot: unknown


Date de réception du rapport
2022-03-04
Date à laquelle le formulaire est complèté
Date de vaccination
2021-11-11
Date d’apparition
0
Nombre de jours (date d’apparition – date de vaccination)
0
Description de l’événement indésirable

stevens-johnson syndrome; mouth swelling; mouth ulcer; this is a spontaneous report received from a contactable reporter(s) (other hcp) from the regulatory authority. other case identifier(s): gb-mhra-vac-202202131410471190-pczyp (agency), gb-mhra-adr 26598471 (agency). a 14 year-old male patient received bnt162b2 (comirnaty), administration date 11nov2021 (batch/lot number: unknown) as dose 1, single for covid-19 immunisation. the patient's relevant medical history and concomitant medications were not reported. the following information was reported: stevens-johnson syndrome (medically significant), outcome "unknown", described as "stevens-johnson syndrome"; mouth ulceration (medically significant) with onset 11nov2021, outcome "recovered", described as "mouth ulcer"; mouth swelling (medically significant), outcome "unknown", described as "mouth swelling". the reporter did not think this reaction occurred as a result of a mistake made in the administration of the vaccine. no follow-up attempts are possible; information about lot/batch number cannot be obtained. no further information is expected

Données de laboratoire
na
Liste des symptômes
mouth ulceration stevens-johnson syndrome mouth swelling
Patient décédé?
Non
Date de décès
N/A
Anomalie congénitale
false
Vaccin administré par :
Other
Vaccin acheté par :
Inconnu
Visite d’un patient à l’urgence?
Non
Patient hospitalisé?
Non
Séjour à l’hôpital
Non
Nombre de jours à l’hôpital
Non spécifié
Invalidité permanente?
Non
Allergies:
na
Maladie actuelle
na