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VAERS Report 2156797

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: em4965


Date report was received
2022-03-04
Date form completed
Date Vaccinated
2021-04-25
Date of Onset
0
Number of days (onset date – vaccination date)
0
Adverse Event Description

tia; central retinal vein occlusion; inappropriate schedule of vaccine administered; this is a spontaneous report received from a contactable reporter(s) (consumer or other non hcp) from the regulatory authority. regulatory number: gb-mhra-webcovid-202202171239418250-imiht (ra). other case identifier(s): gb-mhra-adr 26612635 (ra). a 65 year-old male patient received bnt162b2 (pfizer-biontech covid-19 vaccine, solution for injection), administration date 25apr2021 (lot number: em4965) as dose 2, single for covid-19 immunisation. relevant medical history included: "prostate cancer", start date: sep2015 (unspecified if ongoing); "pituitary tumour benign" (unspecified if ongoing); "pituitary cyst" (unspecified if ongoing); "brachytherapy to prostate" (unspecified if ongoing); "prostate cancer nos" (unspecified if ongoing). it was also reported that the benign pituitary tumor was currently being monitored. the prostate cancer in sep2015 was treated by brachytherapy. the patient has not had symptoms associated with covid-19, has not tested positive for covid-19 since having the vaccine and is not enrolled in clinical trial. concomitant medications included: cabergoline taken for pituitary tumour benign, start date: 01jan2010; levothyroxine taken for pituitary cyst, start date: 01jan2010; sildenafil taken for brachytherapy to prostate, start date: 10oct2015; tamsulosin taken for prostate cancer, start date: 15sep2015; tostran taken for pituitary tumour benign, start date: 01jan2010. vaccination history included: bnt162b2 (dose 1; batch/lot number: er1471), administration date: 25feb2021, for covid-19 immunisation. the following information was reported: retinal vein occlusion (disability, medically significant) with onset 12aug2021, outcome "recovering", described as "central retinal vein occlusion"; transient ischaemic attack (disability, medically significant), outcome "unknown", described as "tia"; inappropriate schedule of product administration (non-serious) with onset 25apr2021, outcome "unknown", described as "inappropriate schedule of vaccine administered". central retinal vein occlusion may have been caused by a tia, no other symptoms from tia. the patient underwent the following laboratory tests and procedures: blood test: (17sep2021) unknown results; computerised tomogram head: (17sep2021) unknown results; heart rate: (17sep2021) unknown results; sars-cov-2 test: (unspecified date) negative; ultrasound doppler: (17sep2021) unknown results. no follow-up attempts are possible. no further information is expected

Lab Data
test date: 20210917; test name: blood tests; result unstructured data: test result:unknown results; test date: 20210917; test name: head ct scan; result unstructured data: test result:unknown results; test date: 20210917; test name: heart monitor; result unstructured data: test result:unknown results; test name: covid-19 virus test; test result: negative ; test date: 20210917; test name: doppler scan on carotid artery; result unstructured data: test result:unknown results
List of symptoms
ultrasound doppler inappropriate schedule of product administration retinal vein occlusion sars-cov-2 test transient ischaemic attack blood test computerised tomogram head heart rate
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?
Yes
Allergies:
na
Current Illness
na