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VAERS Report 2157306

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: 1f1012a


Date report was received
2022-03-04
Date form completed
Date Vaccinated
2021-11-22
Date of Onset
9
Number of days (onset date – vaccination date)
9
Adverse Event Description

pfizer covid vaccine pericarditis; this is a spontaneous report received from a contactable reporter(s) (consumer or other non hcp) from the ra-web. regulatory number: it-minisal02-842700. a 42 year-old male patient received bnt162b2 (comirnaty), intramuscular, administered in arm left, administration date 22nov2021 (lot number: 1f1012a) as dose 3 (booster), single for covid-19 immunisation. the patient's relevant medical history and concomitant medications were not reported. vaccination history included: covid-19 vaccine (dose 1, manufacturer unknown), for covid-19 immunisation; covid-19 vaccine (dose 2, manufacturer unknown), for covid-19 immunisation. the following information was reported: pericarditis (medically significant) with onset 01dec2021, outcome "recovered with sequelae", described as "pfizer covid vaccine pericarditis". the patient underwent the following laboratory tests and procedures: echocardiogram: unknown; impaired quality of life: 8/10. therapeutic measures were taken as a result of pericarditis. changed gravity: pericarditis present in ime list. actions taken (anti-inflammatory therapy with colchicine after echocardium) - impact on quality of life (8/10). no follow-up attempts are possible. no further information is expected

Lab Data
test name: echocardium; result unstructured data: test result:unknown; test name: impaired quality of life; result unstructured data: test result:8/10
List of symptoms
impaired quality of life pericarditis echocardiogram
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