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VAERS Report 2156653

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: fk9706


Date de réception du rapport
2022-03-04
Date à laquelle le formulaire est complèté
Date de vaccination
2021-12-20
Date d’apparition
40
Nombre de jours (date d’apparition – date de vaccination)
40
Description de l’événement indésirable

myocarditis; this is a spontaneous report received from a contactable reporter(s) (consumer or other non hcp) from the regulatory authority. other case identifier(s): gb-mhra-vac-202202231019109640-tbfh3, gb-mhra-adr 26640624, gb-mhra-vac-202202231019109640-tbfh3. a 43 year-old male patient received bnt162b2 (comirnaty), administration date 20dec2021 (lot number: fk9706) as dose number unknown (booster), single for covid-19 immunisation. the patient's relevant medical history and concomitant medications were not reported. vaccination history included: covid-19 vaccine (primary immunization series complete; unknown manufacturer), for covid-19 immunisation. the following information was reported: myocarditis (hospitalization, medically significant) with onset 29jan2022, outcome "recovering", described as "myocarditis". the patient was hospitalized for myocarditis (start date: 2022). 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
myocarditis
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?
Oui
Séjour à l’hôpital
Non
Nombre de jours à l’hôpital
Non spécifié
Invalidité permanente?
Non
Allergies:
na
Maladie actuelle
na