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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1326167

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Case Details

VAERS ID: 1326167 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Massachusetts  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Myocarditis
SMQs:, Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021495809

Write-up: myocarditis; This is a spontaneous report from a non-contactable other HCP via a Pfizer sales representative. A 28-year-old patient of an unspecified gender received second dose of BNT162B2 (Lot Number: Unknown) via an unspecified route of administration on an unspecified date as single dose for covid-19 immunisation. The patient''s medical history and concomitant medications were not reported. Unknown if diagnosed with COVID-19 prior vaccination, and unknown if COVID-19 tested post vaccination. The patient was diagnosed with myocarditis following second dose vaccine on unknown date. Event resulted in doctor or other healthcare professional office/clinic visit. The patient was seen at a Medical Center for treatment and diagnosis. The outcome of event was unknown. Information on the lot/batch number has been requested.; Sender''s Comments: Based on the information provided, A possible contributory role of the suspect product to the development of Myocarditis cannot be excluded. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.


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