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VAERS Report 2156685

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
2022-02-04
Date d’apparition
0
Nombre de jours (date d’apparition – date de vaccination)
0
Description de l’événement indésirable

passed out; felt unwell; patient received fourth (booster) dose of comirnaty; this is a spontaneous report received from a contactable reporter(s) (consumer or other non healthcare professional) from the regulatory agency. the reporter is the patient. regulatory number: gb-mhra-webcovid-202202111806005310-4r62j. other case identifier(s): gb-mhra-adr 26602195. an 83 year-old male patient received bnt162b2 (comirnaty), administration date 04feb2022 (batch/lot number: unknown) as dose 4 (booster), single for covid-19 immunisation. relevant medical history included: "lymphoma", stop date: dec2019. family history included: "neoplasm" (unspecified if ongoing), notes: recently had treatment for cancer, leukaemia or lymphoma (radiotherapy or chemotherapy). the patient had finished treatment for lymphoma in 2019 dec. the patient had no symptoms associated with covid-19 and was not enrolled in clinical trial. the patient's concomitant medications were not reported. vaccination history included: covid-19 vaccine (dose 3; manufacturer unknownbatch number: unknown route of administration: unknown), for covid-19 immunisation; covid-19 vaccine (dose 2; manufacturer unknownbatch number: unknown route of administration: unknown), for covid-19 immunisation; covid-19 vaccine (dose 1; manufacturer unknownbatch number: unknown route of administration: unknown), for covid-19 immunisation. the following information was reported: off label use (hospitalization) with onset 04feb2022, outcome "unknown", described as "patient received fourth (booster) dose of comirnaty"; loss of consciousness (hospitalization, medically significant) with onset 05feb2022, outcome "recovered" (05feb2022), described as "passed out"; malaise (hospitalization) with onset 05feb2022, outcome "unknown", described as "felt unwell". the patient was hospitalized for loss of consciousness, malaise (start date: 05feb2022 for two nights). the patient underwent the following laboratory tests and procedures: chest x-ray: unknown results; echocardiogram: unknown results; sars-cov-2 test: negative; scan brain: unknown results. the patient had not tested positive for covid-19 since having the vaccine. the report of the patient was not related to possible inflammation of the heart (myocarditis or pericarditis). no follow-up attempts are possible; information about lot/batch number cannot be obtained. no further information is expected

Données de laboratoire
test name: chest x-ray; result unstructured data: test result:unknown results; test name: echocardiogram; result unstructured data: test result:unknown results; test name: covid-19 virus test; test result: negative ; test name: head scan; result unstructured data: test result:unknown results
Liste des symptômes
malaise loss of consciousness chest x-ray sars-cov-2 test echocardiogram off label use scan brain
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