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VAERS Report 2156879

Case Report Section

Vaer Report Details

Age: NA

Gender: Unknown

State: Outside US

Patient Died?
Vaccine information


Type: Coronavirus 2019 vaccine

Manufacturer: PFIZER

Lot: fk9712

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

abnormal ecg; muscle weakness; heart pounding/palpitations; shortness of breath; body jolts; primary immunisation: unknown manufacturer and astrazeneca; booster: comirnaty; primary immunisation: unknown manufacturer and astrazeneca; booster: comirnaty; 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-202202231035367540-v2jhi (ra). other case identifier(s): gb-mhra-adr 26639509 (ra). a 64 year-old patient received bnt162b2 (comirnaty), administration date 07dec2021 (lot number: fk9712) as dose 3 (booster), single for covid-19 immunisation. the patient's relevant medical history and concomitant medications were not reported. vaccination history included: astrazenecacovid-19vaccine (dose number unknown, single; lot number: unknown), administration date: 18mar2021, for covid-19 immunisation; covid-19 vaccine (dose number unknown, manufacturer unknown), for covid-19 immunisation. the following information was reported: off label use (medically significant), interchange of vaccine products (medically significant) all with onset 07dec2021, outcome "unknown" and all described as "primary immunisation: unknown manufacturer and astrazeneca; booster: comirnaty"; electrocardiogram abnormal (medically significant), outcome "not recovered", described as "abnormal ecg"; muscular weakness (medically significant), outcome "not recovered", described as "muscle weakness"; palpitations (medically significant), outcome "recovered with sequelae", described as "heart pounding/palpitations"; dyspnoea (medically significant), outcome "unknown", described as "shortness of breath"; tremor (medically significant) with onset 07dec2021, outcome "unknown", described as "body jolts". the patient underwent the following laboratory tests and procedures: electrocardiogram: abnormal; sars-cov-2 test: no - negative covid-19 test. clinical course: the patient reported that about 5 minutes of given the vaccine, 2 bouts of body jolts. the patient started to notice heart pounding after 5 to10 days; contacted emergency number leading into week 3. the patient underwent ecg test 3 times; one at accident and emergency (a and e) department, home visit and at test centre. the patient reported that pounding had reduced but not back to normal. the patient got some sleep now. the patient also had muscle weakness in the triceps, biceps and legs ,especially in the right legs. the patient had no symptoms associated with covid-19 and was not enrolled in the clinical trial. the patient had not been tested for covid-19 since the vaccine. the report was related to possible inflammation of the heart (myocarditis or pericarditis). the symptoms did not lead to a hospital stay. no follow-up attempts are possible. no further information is expected

Lab Data
test name: ecg; result unstructured data: test result:abnormal; comments: test 3 times; test name: covid-19 virus test; result unstructured data: test result:no - negative covid-19 test
List of symptoms
tremor dyspnoea palpitations electrocardiogram abnormal muscular weakness interchange of vaccine products electrocardiogram sars-cov-2 test off label use
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