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VAERS Report 2157326

Case Report Section

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
Date of Onset
0
Number of days (onset date – vaccination date)
0
Adverse Event Description

urticaria nos; this is a spontaneous report received from a contactable reporter(s) (other hcp) from the regulatory authority. regulatory number: it-minisal02-842927. a 55 year-old male patient received bnt162b2 (comirnaty), administered in deltoid left (lot number: 1f1012a) 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 (dose 1; manufacturer unknown), for covid-19 immunization; covid-19 vaccine (dose 2; manufacturer unknown), for covid-19 immunization. the following information was reported: urticaria (medically significant) with onset 17dec2021, outcome "not recovered", described as "urticaria nos". no follow-up attempts are possible. no further information is expected

Lab Data
na
List of symptoms
urticaria
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