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VAERS Report 2157118

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: fe2296


Date report was received
2022-03-04
Date form completed
Date Vaccinated
2021-07-21
Date of Onset
166
Number of days (onset date – vaccination date)
166
Adverse Event Description

peripheral embolism; this is a spontaneous report received from a contactable reporter(s) (physician) from the regulatory authority web. regulatory number: hu-ogyi-0027222. a 63 year-old female patient received bnt162b2 (comirnaty), intramuscular, administered in arm left, administration date 21jul2021 (lot number: fe2296) as dose 2, 0.3 ml single for covid-19 immunisation. relevant medical history included: "hypertension" (ongoing). concomitant medication(s) included: lisonorm taken for hypertension, start date: 03mar2015; rawel taken for hypertension, start date: 01aug2018. vaccination history included: comirnaty (for dose 1, comirnaty, route of administration: intramuscular, anatomical location: left arm, date of administration: 01jul2021 , lot/batch number: fd0168), administration date: 01jul2021, when the patient was 63 years old, for covid-19 immunization. the following information was reported: peripheral embolism (hospitalization) with onset 03jan2022, outcome "recovering", described as "peripheral embolism". sender's comirnaty, peripheral embolism is not listed and not expected. tto is circa 5 months. dechallenge and rechallenge were not applicable. the causal relationship between the suspected drug and the event is considered unlikely. the case is considered serious due to reported hospitalization. no follow-up attempts are possible. no further information is expected

Lab Data
na
List of symptoms
peripheral embolism
Patient Died?
No
Date Died
NA
Birth defect
false
Vaccine Administered By:
Other
Vaccine Purchased By:
Unknown
Patient visit ER?
No
Patient Hospitalized?
Yes
Stay in hospital
No
Days in hospital
Unspecified
Permanent disability?
No
Allergies:
na
Current Illness
hypertension