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: fg6270
- Date report was received
- 2022-03-04
- Date form completed
- Date Vaccinated
- 2021-10-12
- Date of Onset
- 116
- Number of days (onset date – vaccination date)
- 116
- Adverse Event Description
-
postural instability due to probable cerebral ischemia; probable cerebral ischemia; this is a spontaneous report received from a contactable reporter(s) (physician) from the regulatory authority-web. regulatory number: it-minisal02-842621. a 85 year-old male patient received bnt162b2 (comirnaty), intramuscular, administered in arm left, administration date 12oct2021 15:00 (lot number: fg6270, expiration date: 31mar2022) as dose 3 (booster), 0.3 ml single for covid-19 immunisation. the patient's relevant medical history and concomitant medications were not reported. vaccination history included: covid-19 vaccine (first dose, unknown manufacturer), for covid-19 immunisation; covid-19 vaccine (second dose, unknown manufacturer), for covid-19 immunisation. the following information was reported: balance disorder (hospitalization) with onset 05feb2022, outcome "unknown", described as "postural instability due to probable cerebral ischemia"; cerebral ischaemia (hospitalization) with onset 05feb2022, outcome "unknown", described as "probable cerebral ischemia". no follow-up attempts are possible. no further information is expected
- Lab Data
-
na
- List of symptoms
-
balance disorder cerebral ischaemia
- 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