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VAERS Report 2157410

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: 1f1016a


Date report was received
2022-03-04
Date form completed
Date Vaccinated
2021-11-17
Date of Onset
91
Number of days (onset date – vaccination date)
91
Adverse Event Description

abdominal aortic aneurysm and positivity to sars cov 2 in vaccinated with 3rd dose; abdominal aortic aneurysm and positivity to sars cov 2 in vaccinated with 3rd dose; abdominal aortic aneurysm and positivity to sars cov 2 in vaccinated with 3rd dose; this is a spontaneous report received from a contactable reporter(s) (physician) from the regulatory authority-web and product quality group. regulatory number: it-minisal02-846301. a 77 year-old male patient received bnt162b2 (comirnaty), intramuscular, administered in arm left, administration date 17nov2021 08:50 (lot number: 1f1016a, expiration date: 30apr2022) as dose 3 (booster), 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, manufacturer unknown), for covid-19 immunisation; covid-19 vaccine (dose 2, manufacturer unknown), for covid-19 immunisation. the following information was reported: covid-19 (medically significant, life threatening), drug ineffective (medically significant, life threatening), aortic aneurysm (life threatening) all with onset 16feb2022, outcome "recovering" and all described as "abdominal aortic aneurysm and positivity to sars cov 2 in vaccinated with 3rd dose". the patient underwent the following laboratory tests and procedures: sars-cov-2 test: (18feb2022) positive. no follow-up attempts are needed. no further information is expected

Lab Data
test date: 20220218; test name: covid-19 pcr test; result unstructured data: test result:positive
List of symptoms
drug ineffective covid-19 sars-cov-2 test aortic aneurysm
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