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This is VAERS ID 1711627

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History of Changes from the VAERS Wayback Machine

First Appeared on 9/24/2021

VAERS ID: 1711627
VAERS Form:2
Age:
Sex:Female
Location:Wisconsin
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Pericarditis

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USPFIZER INC202101146047

Write-up: Her friend has had both Covid 19 vaccines and has developed pericarditis; This is a spontaneous report from a contactable consumer (patient''s friend) via the Pfizer-sponsored Program. A female patient of an unspecified age received the first dose of BNT162B2 (PFIZER BIONTECH COVID-19 VACCINE) via an unspecified route of administration on an unspecified date (batch/lot number was not reported) as DOSE 1, SINGLE and received the second dose of BNT162B2 (PFIZER BIONTECH COVID-19 VACCINE) via an unspecified route of administration on an unspecified date (batch/lot number was not reported) as DOSE 2, SINGLE for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. The consumer reported that her friend has had both COVID-19 vaccines and has developed pericarditis on an unspecified date. Her friend will have some tests next week. The outcome of the event pericarditis was unknown. The batch/lot numbers for BNT162B2 were not provided and will be requested during follow-up.

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