Vaer Report Details
Age: 46 years old
Gender: Male
State: Outside US
- Patient Died?
- No
- Vaccine information
-
Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Type: Coronavirus 2019 vaccine
Manufacturer: PFIZER
Lot: ep2166
- Date report was received
- 2022-03-04
- Date form completed
- Date Vaccinated
- 2021-03-09
- Date of Onset
- 0
- Number of days (onset date – vaccination date)
- 0
- Adverse Event Description
-
headache; decreased vision; numbness on the left side of the body; internal burning in the left thoracic area; skin irritation; this is a spontaneous report received from a contactable reporter(s) (consumer or other non hcp) from the regulatory authority web. regulatory number: it-minisal02-842937. a 46 year-old male patient received bnt162b2 (comirnaty), intramuscular, administration date 09mar2021 (lot number: ep2166) at the age of 46 years as dose 2, 0.3 ml, single for covid-19 immunisation. relevant medical history included: "allergies related to seasonal changes" (unspecified if ongoing); "hepatitis b" (unspecified if ongoing). the patient's concomitant medications were not reported. vaccination history included: comirnaty (dose 1, single, batch/lot number: ej6790), administration date: 16feb2021, for covid-19 immunization. the following information was reported: headache (disability) with onset 09mar2021, outcome "not recovered", described as "headache"; visual impairment (disability) with onset 09mar2021, outcome "not recovered", described as "decreased vision"; hypoaesthesia (disability) with onset 09mar2021, outcome "not recovered", described as "numbness on the left side of the body"; chest pain (disability) with onset 09mar2021, outcome "not recovered", described as "internal burning in the left thoracic area"; skin irritation (disability) with onset 09mar2021, outcome "not recovered", described as "skin irritation". the patient underwent the following laboratory tests and procedures: magnetic resonance imaging head: not reported; ultrasound scan: not reported. clinical course: patient received the third dose of bnt162b2 (comirnaty) into the right shoulder on 16dec2021 administration date 09mar2021 (lot number: fk6304 ) as dose 3, booster, single for covid-19 immunization. reporter comment: allergies related to seasonal changes. hepatitis b. no follow-up attempts are possible. no further information is expected.; reporter's comments: allergies related to seasonal changes. hepatitis b
- Lab Data
-
test name: magnetic resonance imaging with contrast of the head; result unstructured data: test result:not reported; test name: ultrasound of the supra-aortic trunks; result unstructured data: test result:not reported
- List of symptoms
-
headache chest pain hypoaesthesia skin irritation visual impairment ultrasound scan magnetic resonance imaging head
- 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?
- Yes
- Allergies:
-
na
- Current Illness
-
na