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VAERS Report 2156896

Case Report Section

Vaer Report Details

Age: NA

Gender: Male

State: Outside US

Patient Died?
No
Vaccine information

Name: COVID19 (COVID19 (PFIZER-BIONTECH))

Type: Coronavirus 2019 vaccine

Manufacturer: PFIZER

Lot: unknown


Date report was received
2022-03-04
Date form completed
Date Vaccinated
2021-04-28
Date of Onset
0
Number of days (onset date – vaccination date)
0
Adverse Event Description

clotting of extracorporeal circuit; painful indigestion; this is a spontaneous report received from a contactable reporter (consumer) from the regulatory agency. regulatory number: gb-mhra-webcovid-202202241258282540-optjo. other case identifier(s): gb-mhra-adr 26648987. a 78 year-old male patient received bnt162b2, administration date 28apr2021 (batch/lot number: unknown) as dose 2, single for covid-19 immunisation. relevant medical history included: "blood pressure" (unspecified if ongoing), notes: mild blood pressure detected 5 years ago which responded well to treatment. patient was always active and fit apart from mild blood pressure detected 5 years ago which responded well to treatment. patient did not have symptoms associated with covid-19. patient was not enrolled in clinical trial. 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: dyspepsia (hospitalization) with onset apr2021, outcome "recovered", described as "painful indigestion"; thrombosis in device (hospitalization, medically significant) with onset 29apr2021, outcome "recovered with sequelae", described as "clotting of extracorporeal circuit". the patient was hospitalized for dyspepsia, thrombosis in device (start date: apr2021). within 24 hours suffered painful 'indigestion', within 48 hours was admitted to a cardiac hospital and had a stent implant. from this point on after discharge recovery was slow and took some time to get back to swimming a mile a day and 10 miles country terrain walks. as things stand will not be having the booster. the patient underwent the following laboratory tests and procedures: sars-cov-2 test: no - negative covid-19 test. patient did not test positive for covid-19 since having the vaccine. therapeutic measures were taken as a result of thrombosis in device. no follow-up attempts are possible; information about lot/batch number cannot be obtained. 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
thrombosis in device dyspepsia sars-cov-2 test
Patient Died?
No
Date Died
NA
Birth defect
false
Vaccine Administered By:
Other
Vaccine Purchased By:
Unknown
Patient visit ER?
No
Patient Hospitalized?
Yes
Stay in hospital
No
Days in hospital
Unspecified
Permanent disability?
No
Allergies:
na
Current Illness
na