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VAERS Report 2115853

Case Report Section

Détails du rapport Vaer

Âge: 12 ans

Genre: Female

Région : Outside US

Patient décédé?
Non
Renseignements sur les vaccins

Nom: COVID19 (COVID19 (PFIZER-BIONTECH))

Type : Coronavirus 2019 vaccine

Fabricant: PFIZER

Lot: fk6303


Date de réception du rapport
2022-02-16
Date à laquelle le formulaire est complèté
Date de vaccination
2021-12-17
Date d’apparition
0
Nombre de jours (date d’apparition – date de vaccination)
0
Description de l’événement indésirable

suspicion of trochlear nerve palsy; double vision (suspicion of inc. trochlear nerve palsy); dizziness; headache; this is a spontaneous report received from a contactable reporter(s) (physician) from the regulatory authority-web. regulatory number: at-basgages-2021-076960 (ra). a 12 year-old female patient received bnt162b2 (comirnaty), administration date 17dec2021 (lot number: fk6303) at the age of 12 years as dose 2, single for covid-19 immunisation. the patient's relevant medical history and concomitant medications were not reported. vaccination history included: comirnaty (dose 1), for covid-19 immunisation. the following information was reported: ivth nerve paralysis (hospitalization, medically significant) with onset 21dec2021, outcome "not recovered", described as "suspicion of trochlear nerve palsy"; diplopia (hospitalization, medically significant) with onset 21dec2021, outcome "not recovered", described as "double vision (suspicion of inc. trochlear nerve palsy)"; dizziness (non-serious) with onset 17dec2021, outcome "not recovered", described as "dizziness"; headache (non-serious) with onset 17dec2021, outcome "not recovered", described as "headache". no follow-up attempts are possible. no further information is expected

Données de laboratoire
na
Liste des symptômes
headache dizziness diplopia ivth nerve paralysis
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