Page breadcrumb nav

VAERS Report 2115855

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: fh0106


Date de réception du rapport
2022-02-16
Date à laquelle le formulaire est complèté
Date de vaccination
2021-11-19
Date d’apparition
20
Nombre de jours (date d’apparition – date de vaccination)
20
Description de l’événement indésirable

occlusive retinal vasculitis with retinitis/retinal necrosis; retinal necrosis; retinitis; this is a spontaneous report received from a contactable reporter(s) (physician) from the ra. regulatory number: at-basgages-2021-077076 (ra). a 40 year-old male patient received bnt162b2 (comirnaty), intramuscular, administration date 19nov2021 (lot number: fh0106) as dose 3 (booster), single for covid-19 immunisation. relevant medical history included: "intermediate uveitis", start date: 2016 (ongoing). the patient's concomitant medications were not reported. past drug history included: humira, stop date: nov2020. vaccination history included: comirnaty (dose 1, single), administration date: 14apr2021, for covid-19 immunisation; comirnaty (dose 2, single), administration date: 19may2021, for covid-19 immunisation. the following information was reported: retinal vasculitis (hospitalization, medically significant) with onset 09dec2021 06:30, outcome "recovered with sequelae", described as "occlusive retinal vasculitis with retinitis/retinal necrosis"; necrotising retinitis (hospitalization, medically significant) with onset 09dec2021 06:30, outcome "recovered with sequelae", described as "retinal necrosis"; retinitis (hospitalization, medically significant) with onset 09dec2021 06:30, outcome "recovered with sequelae", described as "retinitis". no follow-up attempts are possible. no further information is expected

Données de laboratoire
na
Liste des symptômes
retinitis retinal vasculitis necrotising retinitis
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
intermediate uveitis