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VAERS Report 2156928

Case Report Section

Vaer Report Details

Age: 12 years old

Gender: Female

State: Outside US

Patient Died?
No
Vaccine information

Name: COVID19 (COVID19 (PFIZER-BIONTECH))

Type: Coronavirus 2019 vaccine

Manufacturer: PFIZER

Lot: fm3092


Date report was received
2022-03-04
Date form completed
Date Vaccinated
2022-02-26
Date of Onset
0
Number of days (onset date – vaccination date)
0
Adverse Event Description

nausea; fever; chills; arm pain at vaccination site; dose 1: 03nov2021 and dose 2: 26feb2022; this is a spontaneous report received from a contactable reporter (consumer) from the regulatory authority (ra). regulatory number: gb-mhra-webcovid-202202270801318190-es8sa. other case identifier(s): gb-mhra-adr 26657087. a 12 year-old female patient received bnt162b2 (comirnaty), administration date 26feb2022 (lot number: fm3092) at the age of 12 years as dose 2, single for covid-19 immunisation. the patient's relevant medical history and concomitant medications were not reported. vaccination history included: comirnaty (dose 1, single; lot number: unknown), administration date: 03nov2021, for covid-19 immunisation. the following information was reported: nausea (medically significant) with onset 26feb2022, outcome "recovering", described as "nausea"; pyrexia (medically significant) with onset 26feb2022, outcome "not recovered", described as "fever"; chills (medically significant) with onset 26feb2022, outcome "recovering", described as "chills"; vaccination site pain (medically significant) with onset 26feb2022, outcome "unknown", described as "arm pain at vaccination site"; inappropriate schedule of product administration (non-serious) with onset 26feb2022, outcome "unknown", described as "dose 1: 03nov2021 and dose 2: 26feb2022". the clinical course was reported as follows: the patient had arm pain at vaccination site occurred from an hour after vaccination. nausea, fever and chills occurred about 12-14 hours after vaccination. the patient had no symptoms associated with covid-19 and did not undergo a covid-19 test. the patient was not enrolled in clinical trial. the patient was not tested positive for covid-19 since the vaccination. the report of the patient was not related to possible inflammation of the heart (myocarditis or pericarditis). no follow-up attempts are possible. no further information is expected

Lab Data
na
List of symptoms
chills nausea pyrexia inappropriate schedule of product administration vaccination site pain
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