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VAERS Report 2156891

Case Report Section

Vaer Report Details

Age: 13 years old

Gender: Male

State: Outside US

Patient Died?
No
Vaccine information

Name: COVID19 (COVID19 (PFIZER-BIONTECH))

Type: Coronavirus 2019 vaccine

Manufacturer: PFIZER

Lot: fl9994


Date report was received
2022-03-04
Date form completed
Date Vaccinated
2022-02-20
Date of Onset
0
Number of days (onset date – vaccination date)
0
Adverse Event Description

backache; toe cramps; eye pain; numbness in face; headache; application site numbness; this is a spontaneous report received from a contactable reporter(s) (consumer or other non hcp) from a regulatory authority. regulatory number: gb-mhra-webcovid-202202240813490130-sqa7s. other case identifier(s): gb-mhra-adr 26645250. a 13 year-old male patient received bnt162b2 (comirnaty), administration date 20feb2022 (lot number: fl9994) at the age of 13 years as dose 2, single for covid-19 immunisation. relevant medical history included: "suspected covid-19", stop date: 23feb2022, notes: unsure when symptoms started. the patient's concomitant medications were not reported. vaccination history included: covid-19 vaccine (dose 1; manufacturer unknown), for covid-19 immunisation. the following information was reported: headache (medically significant) with onset 20feb2022, outcome "recovered" (24feb2022), described as "headache"; vaccination site hypoaesthesia (medically significant) with onset 20feb2022, outcome "recovered" (feb2022), described as "application site numbness"; eye pain (medically significant) with onset 21feb2022, outcome "recovering", described as "eye pain"; hypoaesthesia (medically significant) with onset 21feb2022, outcome "recovering", described as "numbness in face"; muscle spasms (medically significant) with onset 22feb2022, outcome "recovered" (23feb2022), described as "toe cramps"; back pain (medically significant) with onset 23feb2022, outcome "recovered" (feb2022), described as "backache". the patient underwent the following laboratory tests and procedures: sars-cov-2 test: no - negative covid-19 test. the patient had not been tested positive for covid-19 since having the vaccine. the patient was not enrolled in clinical trial. no follow-up attempts are needed. no further information is expected

Lab Data
test name: covid-19 virus test; result unstructured data: test result:no - negative covid-19 test
List of symptoms
back pain headache muscle spasms eye pain hypoaesthesia sars-cov-2 test vaccination site hypoaesthesia
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
suspected covid-19 (unsure when symptoms started)