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VAERS Report 2157159

Case Report Section

Vaer Report Details

Age: NA

Gender: Male

State: Outside US

Patient Died?
No
Vaccine information

Name: COVID19 (COVID19 (PFIZER-BIONTECH))

Type: Coronavirus 2019 vaccine

Manufacturer: PFIZER

Lot: fh0114


Date report was received
2022-03-04
Date form completed
Date Vaccinated
2021-11-10
Date of Onset
23
Number of days (onset date – vaccination date)
23
Adverse Event Description

pericarditis as diagnosed by doctors; this is a spontaneous report received from a contactable reporter(s) (consumer or other non hcp) from the regulatory authority-web. the reporter is the patient. regulatory number: ie-hpra-2022-092791. other case identifier(s): ie-hpra-cvarr2022020825758. a 46 year-old male patient received bnt162b2 (comirnaty), administration date 10nov2021 (lot number: fh0114) as dose number unknown (booster), single for covid-19 immunisation. relevant medical history included: "blood cholesterol abnormal" (unspecified if ongoing); "gout" (unspecified if ongoing). concomitant medication(s) included: allopurinol taken for gout; atorvastatin taken for blood cholesterol abnormal. the following information was reported: pericarditis (hospitalization, medically significant, life threatening) with onset 03dec2021, outcome "not recovered", described as "pericarditis as diagnosed by doctors". the event "pericarditis as diagnosed by doctors" was evaluated at the emergency room visit. no follow-up attempts are possible. no further information is expected

Lab Data
na
List of symptoms
pericarditis
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
na