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VAERS Report 2157352

Case Report Section

Détails du rapport Vaer

Âge: N/A

Genre: Male

Région : Outside US

Patient décédé?
Non
Renseignements sur les vaccins

Nom: COVID19 (COVID19 (PFIZER-BIONTECH))

Type : Coronavirus 2019 vaccine

Fabricant: PFIZER

Lot: 33295tb


Date de réception du rapport
2022-03-04
Date à laquelle le formulaire est complèté
Date de vaccination
2022-02-06
Date d’apparition
3
Nombre de jours (date d’apparition – date de vaccination)
3
Description de l’événement indésirable

off label use; interchange of vaccine products; acute myocarditis after third dose sars-cov2 mrna vaccine; this is a spontaneous report received from a contactable reporter(s) (physician) from the regulatory authority-web. regulatory number: it-minisal02-843223. a 15 year-old male patient received bnt162b2 (comirnaty), intramuscular, administered in arm left, administration date 06feb2022 10:00 (lot number: 33295tb) as dose 3 (booster), 30 ug, single for covid-19 immunisation. the patient's relevant medical history and concomitant medications were not reported. vaccination history included: moderna (dose 1), for covid-19 immunisation; moderna (dose 2), for covid-19 immunisation. the following information was reported: off label use (hospitalization), outcome "unknown", described as "off label use"; interchange of vaccine products (hospitalization), outcome "unknown", described as "interchange of vaccine products"; myocarditis (hospitalization, medically significant) with onset 09feb2022, outcome "not recovered", described as "acute myocarditis after third dose sars-cov2 mrna vaccine". the patient underwent the following laboratory tests and procedures: magnetic resonance imaging: unknown results. therapeutic measures were taken as a result of myocarditis. reporter comment: cardiac mri confirmed acute myocarditis with infarct-like presentation, after administration of third dose anti-sars-cov2 mrna vaccine (1 moderna, 2 moderna, 3 pfizer) no follow-up attempts are possible. no further information is expected.; reporter's comments: cardiac mri confirmed acute myocarditis with infarct-like presentation, after administration of third dose anti-sars-cov2 mrna vaccine (1 moderna, 2 moderna, 3 pfizer)

Données de laboratoire
test name: mri; result unstructured data: test result:unknown results
Liste des symptômes
myocarditis interchange of vaccine products magnetic resonance imaging off label use
Patient décédé?
Non
Date de décès
N/A
Anomalie congénitale
false
Vaccin administré par :
Other
Vaccin acheté par :
Inconnu
Visite d’un patient à l’urgence?
Non
Patient hospitalisé?
Oui
Séjour à l’hôpital
Non
Nombre de jours à l’hôpital
Non spécifié
Invalidité permanente?
Non
Allergies:
na
Maladie actuelle
na