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