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VAERS Report 2156875

Case Report Section

Vaer Report Details

Age: NA

Gender: Female

State: Outside US

Patient Died?
Vaccine information


Type: Coronavirus 2019 vaccine

Manufacturer: PFIZER

Lot: unknown

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

41 temperature; disease crohns; primary immunisation: astrazeneca; booster: comirnaty; primary immunisation: astrazeneca; booster: comirnaty; remained ill since discharge; 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-202202222203305330-lzbjl (ra). other case identifier(s): gb-mhra-adr 26636256 (ra). a female patient received bnt162b2 (comirnaty), administration date 23dec2021 (batch/lot number: unknown) 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 astrazeneca (dose 2, single), administration date: 01aug2021, for covid-19 immunisation; covid-19 vaccine astrazeneca (dose 1, single), administration date: 01may2021, for covid-19 immunisation. the following information was reported: off label use (hospitalization, disability, medically significant), interchange of vaccine products (hospitalization, disability, medically significant) all with onset 23dec2021, outcome "unknown" and all described as "primary immunisation: astrazeneca; booster: comirnaty"; crohn's disease (hospitalization, disability, medically significant) with onset 26dec2021, outcome "not recovered", described as "disease crohns"; pyrexia (hospitalization, medically significant) with onset 27dec2021, outcome "unknown", described as "41 temperature"; malaise (hospitalization, disability, medically significant) with onset dec2021, outcome "not recovered", described as "remained ill since discharge". the patient was hospitalized for off label use, interchange of vaccine products, crohn's disease, pyrexia, malaise (start date: 27dec2021, discharge date: 30dec2021, hospitalization duration: 3 day(s)). the patient underwent the following laboratory tests and procedures: body temperature: (26dec2021) 41 degrees; sars-cov-2 test: (unspecified date) no - negative covid-19 test.additional information: hospitalised 4 days after vaccine with 41� temperature. 3 day stay, remained ill since discharge. no previous history of this condition. 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; information about lot/batch number cannot be obtained. no further information is expected

Lab Data
test date: 20211226; test name: body temperature; result unstructured data: test result:41 degree; test name: covid-19 virus test; result unstructured data: test result:no - negative covid-19 test
List of symptoms
malaise pyrexia interchange of vaccine products sars-cov-2 test body temperature off label use crohn's disease
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