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VAERS Report 2156807

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: fk9413


Date report was received
2022-03-04
Date form completed
Date Vaccinated
2021-11-20
Date of Onset
0
Number of days (onset date – vaccination date)
0
Adverse Event Description

hair loss; off label use; interchange of vaccine products; this is a spontaneous report received from a contactable reporter(s) (pharmacist) from the regulatory authority(ra). regulatory number: gb-mhra-webcovid-202202171617407840-3wazm (ra). other case identifier(s): gb-mhra-adr 26614055 (ra). a 73-year-old male patient received bnt162b2 (comirnaty), administration date 20nov2021 (lot number: fk9413) as dose 3 (booster), single for covid-19 immunisation. relevant medical history included: "osteoarthritis" (unspecified if ongoing); "hypertension" (unspecified if ongoing); "high cholesterol" (unspecified if ongoing). the patient's concomitant medications were not reported. vaccination history included: covid-19 vaccine astrazeneca (dose number unknown, single), administration date: 02jul2021, for covid-19 immunisation; covid-19 vaccine (dose number unknown, manufacturer unknown), for covid-19 immunisation. the following information was reported: off label use (disability) with onset 20nov2021, described as "off label use"; interchange of vaccine products (disability) with onset 20nov2021, described as "interchange of vaccine products"; alopecia (disability) with onset 30nov2021, outcome "not recovered", described as "hair loss". the patient underwent the following laboratory tests and procedures: sars-cov-2 test: negative, notes: no - negative covid-19 test. clinical course: patient has not had symptoms associated with covid-19. patient has not tested positive for covid-19 since having the vaccine. patient is not enrolled in clinical trial. the report does not relate to possible blood clots or low platelet counts or to possible myocarditis or pericarditis. no follow-up attempts are possible. no further information is expected

Lab Data
test name: covid-19 virus test; test result: negative ; comments: no - negative covid-19 test
List of symptoms
alopecia interchange of vaccine products sars-cov-2 test off label use
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