Page breadcrumb nav

VAERS Report 2156834

Case Report Section

Vaer Report Details

Age: NA

Gender: Male

State: Outside US

Patient Died?
Vaccine information


Type: Coronavirus 2019 vaccine

Manufacturer: PFIZER

Lot: fk9706

Date report was received
Date form completed
Date Vaccinated
Date of Onset
Number of days (onset date – vaccination date)
Adverse Event Description

shortness of breath; clot blood/blood clot found on my lung; off label use; interchange of vaccine products; this is a spontaneous report received from a contactable reporter(s) (consumer or other non hcp) from the regulatory agency (ra). the reporter is the patient. regulatory number: gb-mhra-webcovid-202202181954180050-ypo2d (ra). other case identifier(s): gb-mhra-adr 26622919 (ra). a 55 year-old male patient received bnt162b2 (comirnaty), administration date 28dec2021 (lot number: fk9706) as dose 3 (booster), single for covid-19 immunisation. the patient's relevant medical history and concomitant medications were not reported. vaccination history included: covid-19 vaccine (dose 1, manufacturer unknown), for covid-19 immunisation; covid-19 vaccine (dose 2, manufacturer unknown), for covid-19 immunisation. the following information was reported: off label use (hospitalization, disability, medically significant, life threatening) with onset 28dec2021, outcome "unknown", described as "off label use"; interchange of vaccine products (hospitalization, disability, medically significant, life threatening) with onset 28dec2021, outcome "unknown", described as "interchange of vaccine products"; dyspnoea (hospitalization, disability, medically significant, life threatening), outcome "recovering", described as "shortness of breath"; pulmonary thrombosis (hospitalization, disability, medically significant, life threatening) with onset jan2022, outcome "recovered" (03jan2022), described as "clot blood/blood clot found on my lung". the events "shortness of breath" and "clot blood/blood clot found on my lung" were evaluated at the physician office visit. the patient underwent the following laboratory tests and procedures: blood test: unknown results; computerised tomogram: blood clot found on my lung; sars-cov-2 test: no - negative covid-19 test. therapeutic measures were taken as a result of dyspnoea, pulmonary thrombosis. additional information: patient has not had symptoms associated with covid-19. patient has not tested positive for covid-19 since having the vaccine. patient was not enrolled in clinical trial. began by shortness of breath. went to gp was put on heart monitor & blood tests taken. call from gp on same day to say he had to go in to local general hospital. put on heart monitor asap. sent for ct scan where blood clot found on his lung. given blood thinning vaccines next day. blood thinners were not dissolving the clot, which was large. by this time he was on oxygen mask. 4 days later he was transferred to the hospital. told he needed operation to remove clot. remained on heart monitor throughout time in hospital. 2 days later he was operated on. was in hospital for total of 10 days. taking blood thinning tablets twice a day. case reported as serious by health authority (life threatening, caused hospitalization, disabling/incapacitating, and other medically important condition). no follow-up attempts are possible. no further information is expected

Lab Data
test name: blood tests; result unstructured data: test result:unknown results; test name: ct scan; result unstructured data: test result:blood clot found on my lung; test name: covid-19 virus test; result unstructured data: test result:no - negative covid-19 test
List of symptoms
dyspnoea interchange of vaccine products computerised tomogram sars-cov-2 test blood test off label use pulmonary thrombosis
Patient Died?
Date Died
Birth defect
Vaccine Administered By:
Vaccine Purchased By:
Patient visit ER?
Patient Hospitalized?
Stay in hospital
Days in hospital
Permanent disability?
Current Illness