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VAERS Report 2156872

Case Report Section

Vaer Report Details

Age: 79 years old

Gender: Male

State: Outside US

Patient Died?
No
Vaccine information

Name: COVID19 (COVID19 (PFIZER-BIONTECH))

Type: Coronavirus 2019 vaccine

Manufacturer: PFIZER

Lot: fm3092


Date report was received
2022-03-04
Date form completed
Date Vaccinated
2022-02-21
Date of Onset
0
Number of days (onset date – vaccination date)
0
Adverse Event Description

the patient received 4th dose of comirnaty; the patient received 4th dose of comirnaty; swollen eyes; swelling of under eyes,bridge of nose and forehead; redness of eyes and cheeks; redness of eyes and cheeks; indentation of left side of face next to eye; this is a spontaneous report received from a contactable reporter(s) (consumer or other non hcp) from the regulatory agency (ra). regulatory number: gb-mhra-webcovid-202202222022380650-1wta9 (ra). other case identifier(s): gb-mhra-adr 26636236 (ra). a 79 year-old male patient received bnt162b2 (comirnaty), administration date 21feb2022 (lot number: fm3092) at the age of 79 years as dose 4 (booster), single for covid-19 immunisation. relevant medical history included: "neoplasm" (unspecified if ongoing), notes: recently had treatment for cancer, leukaemia or lymphoma (radiotherapy or chemotherapy); "clinical trial participant" (unspecified if ongoing); "cancer" (unspecified if ongoing), notes: taking revlimid a cancer maintenance drug. the patient's concomitant medications were not reported. past drug history included: revlimid for cancer. vaccination history included: covid 19 vaccine (dose 3, manfacturer unknown), for covid-19 immunisation; covid 19 vaccine (dose 2, manfacturer unknown), for covid-19 immunisation; covid 19 vaccine (dose 1, manfacturer unknown), for covid-19 immunisation. the following information was reported: off label use (medically significant), immunisation (medically significant) all with onset 21feb2022, outcome "unknown" and all described as "the patient received 4th dose of comirnaty"; eye swelling (medically significant) with onset 21feb2022, outcome "not recovered", described as "swollen eyes"; swelling face (medically significant) with onset 21feb2022, outcome "unknown", described as "swelling of under eyes,bridge of nose and forehead"; ocular hyperaemia (medically significant), erythema (medically significant) all with onset 21feb2022, outcome "unknown" and all described as "redness of eyes and cheeks"; skin indentation (medically significant) with onset 21feb2022, outcome "unknown", described as "indentation of left side of face next to eye". the patient underwent the following laboratory tests and procedures: sars-cov-2 test: (15feb2022) no - negative covid-19 test. the reaction started around 4 hours after vaccine. the patient did not had symptoms associated with covid-19. the patient did not been tested positive for covid-19 since having the vaccine. the report was not related to possible inflammation of the heart (myocarditis or pericarditis). no follow-up attempts are possible. no further information is expected

Lab Data
test date: 20220215; test name: covid-19 virus test; result unstructured data: test result:no - negative covid-19 test
List of symptoms
erythema ocular hyperaemia swelling face sars-cov-2 test immunisation eye swelling off label use skin indentation
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