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VAERS Report 2156811

Case Report Section

Vaer Report Details

Age: 55 years old

Gender: Male

State: Outside US

Patient Died?
No
Vaccine information

Name: COVID19 (COVID19 (PFIZER-BIONTECH))

Type: Coronavirus 2019 vaccine

Manufacturer: PFIZER

Lot: fk0596


Date report was received
2022-03-04
Date form completed
Date Vaccinated
2021-11-13
Date of Onset
0
Number of days (onset date – vaccination date)
0
Adverse Event Description

off label use; interchange of vaccine products; heavy bleeding at time of vaccine; shoulder pain; this is a spontaneous report received from a contactable reporter(s) (consumer or other non hcp) from the regulatory agency. regulatory number: gb-mhra-webcovid-202202171800565610-4v5yu. other case identifier(s): gb-mhra-adr 26614632. a 55-year-old male patient received bnt162b2 (comirnaty), administration date 13nov2021 (lot number: fk0596) at the age of 55 years as dose 3 (booster), single for covid-19 immunization. the patient's relevant medical history and concomitant medications were not reported. vaccination history included: covid-19 vaccine (dose 1; manufactuerer unknown), for covid-19 immunization; covid-19 vaccine (dose 2; manufactuerer unknown), for covid-19 immunization. the patient experienced heavy bleeding at time of vaccine and sharp pain/shoulder pain. patient has not had symptoms associated with covid-19. the following information was reported: off label use (medically significant), outcome "unknown", described as "off label use"; interchange of vaccine products (medically significant), outcome "unknown", described as "interchange of vaccine products"; arthralgia (medically significant) with onset 13nov2021, outcome "not recovered", described as "shoulder pain"; haemorrhage (medically significant), outcome "unknown", described as "heavy bleeding at time of vaccine". the events "shoulder pain" and "heavy bleeding at time of vaccine" were evaluated at the physician office visit. the patient visited a gp and prescribed codeine and 'physio'. therapeutic measures were taken as a result of arthralgia which included codeine. the patient underwent the following laboratory tests and procedures: sars-cov-2 test: negative, notes: no - negative covid-19 test. patient has not tested positive for covid-19 since having the vaccine. patient is not enrolled in clinical trial. 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
arthralgia haemorrhage 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?
No
Allergies:
na
Current Illness
na