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VAERS Report 2156794

Case Report Section

Vaer Report Details

Age: NA

Gender: Male

State: Outside US

Patient Died?
No
Vaccine information

Name: COVID19 (COVID19 (PFIZER-BIONTECH))

Type: Coronavirus 2019 vaccine

Manufacturer: PFIZER

Lot: unknown


Date report was received
2022-03-04
Date form completed
Date Vaccinated
2022-01-04
Date of Onset
22
Number of days (onset date – vaccination date)
22
Adverse Event Description

thrombophlebitis leg; disease recurrence; left superficial thrombophlebitis; this is a spontaneous report received from a contactable reporter(s) (other hcp) from the regulatory authority. regulatory number: gb-mhra-webcovid-202202171152307970-g3h0e. a 34 year-old male patient received bnt162b2 (comirnaty), administration date 04jan2022 (batch/lot number: unknown) as dose 3 (booster), single for covid-19 immunisation. relevant medical history included: "thrombophlebitis" (unspecified if ongoing). the patient's concomitant medications were not reported. vaccination history included: covid 19 vaccine (dose 2; manufactuerer unknown), for covid-19 immunisation; covid 19 vaccine (dose 1; manufactuerer unknown), for covid-19 immunisation. it was unsure if the patient had symptoms associated with covid-19. the patient did not undergo a covid-19 test. the patient was not enrolled in a clinical trial. the following information was reported: thrombophlebitis (medically significant) with onset 26jan2022, outcome "recovering", described as "thrombophlebitis leg"; disease recurrence (medically significant) with onset 26jan2022, outcome "recovering", described as "disease recurrence"; superficial vein thrombosis (medically significant) with onset 26jan2022, outcome "unknown", described as "left superficial thrombophlebitis". the patient underwent the following laboratory tests and procedures: ultrasound doppler: (26jan2022) unknown results. no follow-up attempts are possible; information about lot/batch number cannot be obtained. no further information is expected

Lab Data
test date: 20220126; test name: us doppler; result unstructured data: test result:unknown results
List of symptoms
ultrasound doppler thrombophlebitis disease recurrence superficial vein thrombosis
Patient Died?
No
Date Died
NA
Birth defect
false
Vaccine Administered By:
Other
Vaccine Purchased By:
Unknown
Patient visit ER?
No
Patient Hospitalized?
No
Stay in hospital
No
Days in hospital
Unspecified
Permanent disability?
No
Allergies:
na
Current Illness
na