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VAERS Report 2157435

Case Report Section

Vaer Report Details

Age: NA

Gender: Female

State: Outside US

Patient Died?
No
Vaccine information

Name: COVID19 (COVID19 (PFIZER-BIONTECH))

Type: Coronavirus 2019 vaccine

Manufacturer: PFIZER

Lot: fc5089


Date report was received
2022-03-04
Date form completed
Date Vaccinated
2021-06-25
Date of Onset
0
Number of days (onset date – vaccination date)
0
Adverse Event Description

pericarditis; this is a spontaneous report received from a contactable reporter(s) (consumer or other non hcp) from the ra-web. a 19-year-old female patient received bnt162b2 (comirnaty), administered in arm left, administration date 25jun2021 (lot number: fc5089, expiration date: 31jan2022) as dose 1, single for covid-19 immunisation. the patient's relevant medical history and concomitant medications were not reported. the following information was reported: pericarditis (medically significant), outcome "unknown", described as "pericarditis". the patient underwent the following laboratory tests and procedures: cardiovascular examination: pericarditis; echocardiogram: pericarditis; electrocardiogram: pericarditis; quality of life decreased: 7/10. therapeutic measures were taken as a result of pericarditis. clinical information: undergoing drug treatment. impact on quality of life (7/10). comirnaty dose 2: 31jul2021, lot number: ff7481, expiration date: 31jul2021, intramuscular. not performed 3rd dose no previous covid. follow-up attempts are completed. no further information is expected.; sender's comments: linked report(s) : it-pfizer inc-202200159252 same reporter and patient, different dose and events

Lab Data
test name: cardiological examination; result unstructured data: test result:pericarditis; test name: echocardiogram; result unstructured data: test result:pericarditis; test name: electrocardiogram; result unstructured data: test result:pericarditis; test name: impact on quality of life; result unstructured data: test result:7/10
List of symptoms
pericarditis quality of life decreased electrocardiogram echocardiogram cardiovascular examination
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