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VAERS Report 2157035

Case Report Section

Vaer Report Details

Age: 36 years old

Gender: Female

State: Outside US

Patient Died?
No
Vaccine information

Name: COVID19 (COVID19 (PFIZER-BIONTECH))

Type: Coronavirus 2019 vaccine

Manufacturer: PFIZER

Lot: unknown


Date report was received
2022-03-04
Date form completed
Date Vaccinated
2021-07-15
Date of Onset
0
Number of days (onset date – vaccination date)
0
Adverse Event Description

intense headache,frequent the first 15 days,decreased the next 15 days; vitiligo relapse 7 days since the first dose,other factors excluded; this is a spontaneous report received from a contactable reporter (consumer) from the regulatory authority-web. regulatory number: gr-greof-202108956 (ra). a 36-year-old female patient received bnt162b2 (comirnaty), administration date 15jul2021 (lot number: unknown) at the age of 36 years as dose 1, single for covid-19 immunisation. relevant medical history included: "thyroid gland (has autoimmune disease)" (unspecified if ongoing); "patient was a lactating woman" (unspecified if ongoing). the patient's concomitant medications were not reported. the following information was reported: headache (medically significant) with onset 15jul2021, outcome "recovered", described as "intense headache, frequent the first 15 days, decreased the next 15 days"; vitiligo (medically significant) with onset 15jul2021, outcome "unknown", described as "vitiligo relapse 7 days since the first dose, other factors excluded". clinical course: the patient was a lactating woman. no allergy. non-smoker, no drug abuse. the thyroid gland (has autoimmune disease) was not affected. no follow-up attempts are possible; information about lot/batch number cannot be obtained. no further information is expected

Lab Data
na
List of symptoms
headache vitiligo
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