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VAERS ID: 1000368

AGE: UNK| SEX: M|State: FR

Description

Pulmonary embolus; r pulmonary infarct; r basal pneumonia; embolus in IVC; This is a spontaneous report downloaded from the regulatory authority, GB-MHRA-WEBCOVID-202101221152392810 and GB-MHRA-ADR 24631718. This is a report received from the Regulatory Agency. A 58-year-old male patient received BNT162B2 (PFIZER COVID-19 VACCINE, lot: BN:EK1768), via an unspecified route of administration on 08Jan2021 at single dose for covid-19 immunization. The medical history was not reported. Patient had not tested positive for COVID-19 since having the vaccine. Patient has not had symptoms associated with COVID-19 Patient is not enrolled in clinical trial. Concomitant medication included influenza vaccine (INFLUENZA VIRUS) for immunization. On day of vaccination, patient was fit and well, active and working. Patient developed painful arm and headache 24 hours following the vaccination n Jan2021. Patient developed pleuritic chest pain on 11Jan2021 and medical condition deteriorated over next 24 hours, admitted to hospital on 13Jan2021 and diagnosed with r basal pneumonia, r pulmonary infarct, R pulmonary embolus and embolus in Inferior vena cava (IVC). The events were serious per hospitalization, disability, life threatening. The patient underwent COVID-19 virus test on 19Jan2021 with result no - negative covid-19 test. The outcome of the events was recovering. No follow-up attempts are possible. No further information expected.

Symptoms

Embolism, Pneumonia, Pulmonary embolism, Pulmonary infarction, SARS-CoV-2 test

Vaccines

VAX DATE: 07 January 2021 | ONSET DATE: 31 December 2020 | DAYS TO ONSET:
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • PFIZERBIONTECH
  • COVID19 (COVID19 (PFIZER-BIONTECH))
  • UNK
  • BN:EK1768

RECVDATE:
03 February 2021
CAGE_YR:
CAGE_MO:
RPT_DATE:
DIED:
DATEDIED:
L_THREAT:
Y
ER_VISIT:
HOSPITAL:
Y
HOSPDAYS:
X_STAY:
DISABLE:
Y
RECOVD:
N
LAB_DATA:
Test Date: 20210119; Test Name: COVID-19 virus test; Result Unstructured Data: Test Result:No - Negative COVID-19 test
V_ADMINBY:
OTH
OTHER_MEDS:
INFLUENZA VIRUS
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:
GBPFIZER INC2021094638
FORM_VERS:
2
TODAYS_DATE:
02 February 2021
BIRTH_DEFECT:
OFC_VISIT:
ER_ED_VISIT:
ALLERGIES:
V_FUNDBY:
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