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This is VAERS ID 1456709

History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1456709
VAERS Form:2
Age:14.0
Sex:Male
Location:New York
Vaccinated:2021-06-19
Onset:2021-06-01
Submitted:0000-00-00
Entered:2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / -

Administered by: Other      Purchased by: ??
Symptoms: Myocarditis, Inflammation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USPFIZER INC2021807456

Write-up: Myocarditis; Her son still has some inflammation; This is a spontaneous report from a contactable other hcp (Patients mother). A 14-years-old male patient received bnt162b2 (BNT162B2, Batch/Lot Number: EW0180 and Expiry Date: 19Jun2021), dose 2 via an unspecified route of administration, administered in Arm Left on 19Jun2021 as single dose for covid-19 immunisation. Patient previously received dose 1 of bnt162b2 (BNT162B2, Lot number: EW0178 and Expiration Date : Unknown to caller ) via an unspecified route of administration on 29May2021 as single dose for covid-19 immunization. The patient''s medical history was not reported. There were no concomitant medications. On 21Jun2021, The patient experienced myocarditis, About 2 days later, he was taken by ambulance to the ER, diagnosed with Myocarditis and admitted to the hospital, discharged on 23Jun2021. Caller states that she believes her son still has some inflammation, it is better but still ongoing, as he is still unable to exert himself at all. The claims are not in yet but it looks like they will be spending 5000 to 6000 dollar out of pocket. She is looking for some type of compensation for their expenses. Patient had no other vaccines on the same day as the suspect product. Myocarditis lead to Emergency Room. The outcome of the event myocarditis was recovering and inflammation was not recovered.; Sender''s Comments: As per the information provided in the narrative, the causal association between the suspect drug and the event 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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