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
- 2022-01-18
- Date of Onset
- 0
- Number of days (onset date – vaccination date)
- 0
- Adverse Event Description
-
pericarditis; this is a spontaneous report received from a contactable reporter(s) (physician) from the ra-web. regulatory number: gr-greof-202200463. a 26 year-old female patient received bnt162b2 (comirnaty), administration date 18jan2022 (batch/lot number: unknown) as dose 3 (booster), single for covid-19 immunisation. the patient's relevant medical history and concomitant medications were not reported. vaccination history included: covid-19 vaccine (dose 1; manufacturer unknown), for covid-19 immunisation; covid-19 vaccine (dose 2; manufacturer unknown), for covid-19 immunisation. the following information was reported: pericarditis (medically significant) with onset 18jan2022, outcome "recovering", described as "pericarditis". no follow-up attempts are possible; information about lot/batch number cannot be obtained. no further information is expected
- Lab Data
-
na
- List of symptoms
-
pericarditis
- 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