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: fh0114
- Date report was received
- 2022-03-04
- Date form completed
- Date Vaccinated
- 2021-11-10
- Date of Onset
- 23
- Number of days (onset date – vaccination date)
- 23
- Adverse Event Description
-
pericarditis as diagnosed by doctors; this is a spontaneous report received from a contactable reporter(s) (consumer or other non hcp) from the regulatory authority-web. the reporter is the patient. regulatory number: ie-hpra-2022-092791. other case identifier(s): ie-hpra-cvarr2022020825758. a 46 year-old male patient received bnt162b2 (comirnaty), administration date 10nov2021 (lot number: fh0114) as dose number unknown (booster), single for covid-19 immunisation. relevant medical history included: "blood cholesterol abnormal" (unspecified if ongoing); "gout" (unspecified if ongoing). concomitant medication(s) included: allopurinol taken for gout; atorvastatin taken for blood cholesterol abnormal. the following information was reported: pericarditis (hospitalization, medically significant, life threatening) with onset 03dec2021, outcome "not recovered", described as "pericarditis as diagnosed by doctors". the event "pericarditis as diagnosed by doctors" was evaluated at the emergency room visit. no follow-up attempts are possible. 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?
- Yes
- Stay in hospital
- No
- Days in hospital
- Unspecified
- Permanent disability?
- No
- Allergies:
-
na
- Current Illness
-
na