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VAERS Report 2156903

Case Report Section

Vaer Report Details

Age: NA

Gender: Unknown

State: Outside US

Patient Died?
No
Vaccine information

Name: COVID19 (COVID19 (PFIZER-BIONTECH))

Type: Coronavirus 2019 vaccine

Manufacturer: PFIZER

Lot: fh0114


Date report was received
2022-03-04
Date form completed
Date Vaccinated
2021-11-05
Date of Onset
0
Number of days (onset date – vaccination date)
0
Adverse Event Description

atrial fibrillation; primary immunisation: non-pfizer vaccine; booster: comirnaty; primary immunisation: non-pfizer vaccine; booster: comirnaty; this is a spontaneous report received from a contactable reporter (physician) from the regulatory agency. regulatory number: gb-mhra-webcovid-202202241734136430-sjbmx. other case identifier(s): gb-mhra-adr 26648355. a patient (no qualifiers provided) received bnt162b2 (comirnaty), administration date 05nov2021 (lot number: fh0114) as dose 3 (booster), single for covid-19 immunisation. the patient's relevant medical history and concomitant medications were not reported. patient did not have symptoms associated with covid-19. patient was not enrolled in clinical trial. vaccination history included: covid-19 vaccine (dose 2; manufacturer unknown), for covid-19 immunisation; covid-19 vaccine (dose 1; 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 05nov2021, outcome "unknown" and all described as "primary immunisation: non-pfizer vaccine; booster: comirnaty"; atrial fibrillation (medically significant) with onset 22feb2022, outcome "not recovered", described as "atrial fibrillation". patient did not have a covid-19 test. no follow-up attempts are possible. no further information is expected

Lab Data
na
List of symptoms
atrial fibrillation interchange of vaccine products off label use
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