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: fn4071
- Date report was received
- 2022-03-04
- Date form completed
- Date Vaccinated
- 2022-02-04
- Date of Onset
- 1
- Number of days (onset date – vaccination date)
- 1
- Adverse Event Description
-
blackout spell; tremor; fall; vagal reaction; this is a spontaneous report received from a contactable reporter(s) (physician) from the agency regulatory authority-web. regulatory number: it-minisal02-842962. a 7 year-old male patient received bnt162b2 (comirnaty), intramuscular, administration date 04feb2022 (lot number: fn4071) as dose 1, 0.2 ml single for covid-19 immunisation. the patient's relevant medical history and concomitant medications were not reported. the following information was reported: loss of consciousness (medically significant) with onset 05feb2022, outcome "recovered" (05feb2022), described as "blackout spell"; tremor (non-serious) with onset 05feb2022, outcome "recovered" (05feb2022), described as "tremor"; fall (non-serious) with onset 05feb2022, outcome "recovered" (05feb2022), described as "fall"; presyncope (non-serious) with onset 05feb2022, outcome "recovered" (05feb2022), described as "vagal reaction". therapeutic measures were taken as a result of loss of consciousness, tremor, fall, presyncope. additional information: the events lasted a few seconds. prompt recovery after administration of glucose and water. no follow-up attempts are possible. no further information is expected
- Lab Data
-
na
- List of symptoms
-
tremor loss of consciousness fall presyncope
- 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