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VAERS Report 2157327

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: fd1921


Date report was received
2022-03-04
Date form completed
Date Vaccinated
2021-06-17
Date of Onset
1
Number of days (onset date – vaccination date)
1
Adverse Event Description

urticaria nos; this is a spontaneous report received from a contactable reporter(s) (other hcp) from the regulatory authority-web. regulatory number: it-minisal02-842928. a 55-year-old male patient received bnt162b2 (comirnaty), intramuscular, administered in deltoid left, administration date 17jun2021 09:45 (lot number: fd1921) as dose 2, 0.3 ml 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, single, manufacturer unknown), for covid-19 immunization. the following information was reported: urticaria (medically significant) with onset 18jun2021, outcome "not recovered", described as "urticaria nos". no follow-up attempts are possible. no further information is expected

Lab Data
na
List of symptoms
urticaria
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