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VAERS Report 2157056

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
2021-04-03
Date of Onset
89
Number of days (onset date – vaccination date)
89
Adverse Event Description

esophagitis; anemia; headache; this is a spontaneous report received from a contactable reporter (physician) from the regulatory authority-web. regulatory number: gr-greof-20217675 (ra). a 77 year-old male patient received bnt162b2 (comirnaty), intramuscular, administration date 03apr2021 (batch/lot number: unknown) as dose 2, single for covid-19 immunisation. the patient's relevant medical history was not reported. concomitant medication(s) included: omnic tocas; coaprovel. vaccination history included: comirnaty (dose 1, batch/lot number :unknown, route of administration: intramuscular), administration date: 13mar2021, for covid-19 immunisation. the following information was reported: oesophagitis (hospitalization, medically significant) with onset 01jul2021, outcome "recovering", described as "esophagitis"; anaemia (hospitalization, medically significant) with onset 01jul2021, outcome "not recovered", described as "anemia"; headache (disability) with onset 01jul2021, outcome "not recovered", described as "headache". the patient underwent the following laboratory tests and procedures: inflammatory marker test: inflammatory markers for an extended period of, notes: time. therapeutic measures were taken as a result of anaemia, headache. clinical details: the patient presented with esophagitis grade 2 with anemia and inflammatory markers for an extended period of time without any other foci of inflammation. headache was localized and did not subside with the usual painkillers. no follow-up attempts are possible; information about lot/batch number cannot be obtained. no further information is expected

Lab Data
test name: inflammatory marker; result unstructured data: test result:inflammatory markers for an extended period of; comments: time
List of symptoms
headache anaemia oesophagitis inflammatory marker 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?
Yes
Allergies:
na
Current Illness
na