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This is VAERS ID 1773619

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/15/2021

VAERS ID: 1773619
VAERS Form:2
Age:
Sex:Female
Location:New York
Vaccinated:2021-07-01
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Myocarditis

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 INC202101275718

Write-up: myocarditis; This is a spontaneous report from a contactable physician and a contactable consumer. A 19-year-old female patient (reporter''s niece) received second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE), via an unspecified route of administration in Jul2021 (Batch/Lot number was not reported) as single dose for COVID-19 immunisation. The patient medical history and concomitant medications were not reported. The patient experienced myocarditis on an unspecified date with outcome of unknown. The lot number for the vaccine, BNT162B2, was not provided and will be requested during follow up.; Sender''s Comments: Based on known drug safety profile and temporal relationship there is reasonable possibility of causal association between the event Myocarditis and the suspect drug BNT162B2. 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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