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VAERS Report 2136796

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: unknown


Date de réception du rapport
2022-02-24
Date à laquelle le formulaire est complèté
Date de vaccination
2021-06-29
Date d’apparition
2
Nombre de jours (date d’apparition – date de vaccination)
2
Description de l’événement indésirable

perimyocarditis; this is a spontaneous report received from a contactable reporter(s) (physician) from the regulatory authority-web. regulatory number: at-basgages-2021-077850. a 20 year-old male patient received bnt162b2 (comirnaty), administration date 29jun2021 (lot number: unknown) as dose 2, single for covid-19 immunisation. the patient had no relevant medical history. the patient's concomitant medications were not reported. vaccination history included: comirnaty (dose 1), for covid-19 immunization. the following information was reported: myocarditis (hospitalization, medically significant) with onset 01jul2021, outcome "recovered", described as "perimyocarditis". relatedness of drug to reaction was assessed by health care professional by assessment method. no follow-up attempts are possible; information about lot/batch number cannot be obtained. no further information is expected

Données de laboratoire
na
Liste des symptômes
myocarditis
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