VAERS ID: 2161826

AGE: 15| SEX: M|STATE: GA

Description

blood clots in both legs; swelling in both legs; This is a spontaneous report received from contactable reporter(s) (Consumer or other non HCP). The reporter is the parent. A 15 year-old male patient received bnt162b2 (BNT162B2), administered in arm right, administration date 03Jul2021 14:00 (Lot number: EW0198) at the age of 15 years as dose 1, single for covid-19 immunisation. The patient had no relevant medical history. There were no concomitant medications. The following information was reported: THROMBOSIS (caused and prolonged hospitalization, medically significant, life threatening) with onset 05Jul2021 13:00, outcome "recovered with sequelae", described as "blood clots in both legs"; PERIPHERAL SWELLING (hospitalization, life threatening) with onset 05Jul2021 13:00, outcome "recovered with sequelae", described as "swelling in both legs". The patient was hospitalized and prolonged hospitalization for thrombosis (hospitalization duration: 7 day(s)); for peripheral swelling (hospitalization duration: 7 day(s)). The events "blood clots in both legs" and "swelling in both legs" were evaluated at the physician office visit and emergency room visit. Therapeutic measures were taken as a result of thrombosis, peripheral swelling. Clinical course: Patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. No List of any other medications the patient received within 2 weeks of vaccination. Prior to vaccination, the patient was not diagnosed with COVID-19 and not tested for COVID-19 since vaccination. Once properly diagnosed after swelling in both legs had to undergo surgery to remove blood clots in both legs just in time before clots moved to his heart or brain. Surgery to rmove blood clots. The patient had no known allergy.

Symptoms

Peripheral swelling, Thrombosis

Vaccines

VAX DATE: 07-03-2021| ONSET DATE: 07-05-2021| DAYS TO ONSET: 2
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH EW0198 Unknown RA

RECVDATE:03-05-2022
RPT_DATE:
CAGE_YR:
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:Y
ER_VISIT:U
HOSPITAL:Y
HOSPDAYS:7
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:
V_ADMINBY:PHM
OTHER_MEDS:
CUR_ILL:
HISTORY:Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None, Comment: known allergies: No other medical history: None
PRIOR_VAX:
SPLTTYPE:USPFIZER INC202200334924
FORM_VERS:2
TODAYS_DATE:03-02-2022
BIRTH_DEFECT:U
OFC_VISIT:Y
ER_ED_VISIT:Y
ALLERGIES:
V_FUNDBY:

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