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: 1f1016a
- Date report was received
- 2022-03-04
- Date form completed
- Date Vaccinated
- 2021-11-17
- Date of Onset
- 91
- Number of days (onset date – vaccination date)
- 91
- Adverse Event Description
-
abdominal aortic aneurysm and positivity to sars cov 2 in vaccinated with 3rd dose; abdominal aortic aneurysm and positivity to sars cov 2 in vaccinated with 3rd dose; abdominal aortic aneurysm and positivity to sars cov 2 in vaccinated with 3rd dose; this is a spontaneous report received from a contactable reporter(s) (physician) from the regulatory authority-web and product quality group. regulatory number: it-minisal02-846301. a 77 year-old male patient received bnt162b2 (comirnaty), intramuscular, administered in arm left, administration date 17nov2021 08:50 (lot number: 1f1016a, expiration date: 30apr2022) 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 immunisation; covid-19 vaccine (dose 2, manufacturer unknown), for covid-19 immunisation. the following information was reported: covid-19 (medically significant, life threatening), drug ineffective (medically significant, life threatening), aortic aneurysm (life threatening) all with onset 16feb2022, outcome "recovering" and all described as "abdominal aortic aneurysm and positivity to sars cov 2 in vaccinated with 3rd dose". the patient underwent the following laboratory tests and procedures: sars-cov-2 test: (18feb2022) positive. no follow-up attempts are needed. no further information is expected
- Lab Data
-
test date: 20220218; test name: covid-19 pcr test; result unstructured data: test result:positive
- List of symptoms
-
drug ineffective covid-19 sars-cov-2 test aortic aneurysm
- 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