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VAERS Report 2156993

Case Report Section

Vaer Report Details

Age: NA

Gender: Female

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
Date of Onset
0
Number of days (onset date – vaccination date)
0
Adverse Event Description

oral lichen planus; lichen planus vagina and skin; symptoms worse; this is a spontaneous report received from a contactable reporter(s) (consumer or other non hcp) from the regulatory agency. a 58 year-old female patient received bnt162b2 (comirnaty) (batch/lot number: unknown) as dose 3 (booster), single for covid-19 immunisation. relevant medical history included: "mastectomy" (unspecified if ongoing), notes: double mastectomy; "breast cancer" (unspecified if ongoing). the patient's concomitant medications were not reported. vaccination history included: bnt162b2 (dose 1, single, lot number:ek4244), administration date: 05feb2021, for covid-19 immunisation, reaction(s): "oral lichen planus"; comirnaty (dose 2, single), for covid-19 immunisation, reaction(s): "lichen plus vagina and skin". the following information was reported: oral lichen planus (disability, medically significant), outcome "unknown", described as "oral lichen planus"; lichen planus (disability, medically significant), outcome "unknown", described as "lichen plus vagina and skin". the event "oral lichen planus" was evaluated at the physician office visit. the patient underwent the following laboratory tests and procedures: biopsy: unknown results; sars-cov-2 test: negative. clinical course: it was reported that, first pfizer vaccine triggered oral lichen planus diagnosed in dental hospital by a consultant, where second dose of pfizer vaccine triggered lichen planus vagina and skin and reported as booster made symptoms worse. no follow-up attempts are possible; information about lot/batch number cannot be obtained. no further information is expected.; sender's comments: linked report(s) : gb-pfizer inc-202200313688 same patient/vaccine product, different dose/events;gb-pfizer inc-202200289957 same patient/vaccine product, different dose/events

Lab Data
test name: biopsy and diagnosis; result unstructured data: test result:unknown results; test name: covid-19 virus test; test result: negative
List of symptoms
condition aggravated biopsy lichen planus sars-cov-2 test oral lichen planus
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?
Yes
Allergies:
na
Current Illness
na