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: 1f1012a
- Date report was received
- 2022-03-04
- Date form completed
- Date Vaccinated
- 2021-11-22
- Date of Onset
- 9
- Number of days (onset date – vaccination date)
- 9
- Adverse Event Description
-
pfizer covid vaccine pericarditis; this is a spontaneous report received from a contactable reporter(s) (consumer or other non hcp) from the ra-web. regulatory number: it-minisal02-842700. a 42 year-old male patient received bnt162b2 (comirnaty), intramuscular, administered in arm left, administration date 22nov2021 (lot number: 1f1012a) 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 01dec2021, outcome "recovered with sequelae", described as "pfizer covid vaccine pericarditis". the patient underwent the following laboratory tests and procedures: echocardiogram: unknown; impaired quality of life: 8/10. therapeutic measures were taken as a result of pericarditis. changed gravity: pericarditis present in ime list. actions taken (anti-inflammatory therapy with colchicine after echocardium) - impact on quality of life (8/10). no follow-up attempts are possible. no further information is expected
- Lab Data
-
test name: echocardium; result unstructured data: test result:unknown; test name: impaired quality of life; result unstructured data: test result:8/10
- List of symptoms
-
impaired quality of life pericarditis echocardiogram
- 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