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: fe2296
- Date report was received
- 2022-03-04
- Date form completed
- Date Vaccinated
- 2021-07-21
- Date of Onset
- 166
- Number of days (onset date – vaccination date)
- 166
- Adverse Event Description
-
peripheral embolism; this is a spontaneous report received from a contactable reporter(s) (physician) from the regulatory authority web. regulatory number: hu-ogyi-0027222. a 63 year-old female patient received bnt162b2 (comirnaty), intramuscular, administered in arm left, administration date 21jul2021 (lot number: fe2296) as dose 2, 0.3 ml single for covid-19 immunisation. relevant medical history included: "hypertension" (ongoing). concomitant medication(s) included: lisonorm taken for hypertension, start date: 03mar2015; rawel taken for hypertension, start date: 01aug2018. vaccination history included: comirnaty (for dose 1, comirnaty, route of administration: intramuscular, anatomical location: left arm, date of administration: 01jul2021 , lot/batch number: fd0168), administration date: 01jul2021, when the patient was 63 years old, for covid-19 immunization. the following information was reported: peripheral embolism (hospitalization) with onset 03jan2022, outcome "recovering", described as "peripheral embolism". sender's comirnaty, peripheral embolism is not listed and not expected. tto is circa 5 months. dechallenge and rechallenge were not applicable. the causal relationship between the suspected drug and the event is considered unlikely. the case is considered serious due to reported hospitalization. no follow-up attempts are possible. no further information is expected
- Lab Data
-
na
- List of symptoms
-
peripheral embolism
- 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?
- No
- Allergies:
-
na
- Current Illness
-
hypertension