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VAERS Report 2136797

Case Report Section

Détails du rapport Vaer

Âge: N/A

Genre: Female

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
2021-12-01
Date d’apparition
0
Nombre de jours (date d’apparition – date de vaccination)
0
Description de l’événement indésirable

deep vein thrombosis; pulmonary artery embolism; dyspnea in pulmonary artery embolism/deep vein thrombosis; inappropriate route of vaccination; this is a spontaneous report received from a contactable reporter(s) (physician) from the regulatory authority. regulatory number: at-basgages-2021-077870 (agency). other case identifier(s): at-pfizer inc-202200240083 (duplicate case). a 79 year-old female patient received bnt162b2 (comirnaty), subcutaneous, administration date 01dec2021 (batch/lot number: unknown) as dose 3 (booster), single for covid-19 immunisation. relevant medical history included: "varicosity" (unspecified if ongoing); "hypertension arterial" (ongoing). the patient's concomitant medications were not reported. vaccination history included: comirnaty (1st dose), for covid-19 immunization; comirnaty (2nd dose), for covid-19 immunization. the following information was reported: deep vein thrombosis (hospitalization, medically significant) with onset 18dec2021, outcome "recovered", described as "deep vein thrombosis"; pulmonary embolism (hospitalization, medically significant) with onset 18dec2021, outcome "recovered", described as "pulmonary artery embolism"; dyspnoea (hospitalization) with onset 18dec2021, outcome "recovered", described as "dyspnea in pulmonary artery embolism/deep vein thrombosis"; incorrect route of product administration (non-serious) with onset 01dec2021, outcome "unknown", described as "inappropriate route of vaccination". clinical course: relatedness of drug to reaction(s)/dyspnoea/ health care professional/ who assessment / possible. 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
dyspnoea incorrect route of product administration pulmonary embolism deep vein thrombosis
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
hypertension arterial