Received Jan 26, 2026
| Type | Name | Manufacturer | Dose | Lot | Route / Site |
|---|---|---|---|---|---|
| COVID19 | COVID19 (COVID19 (PFIZER-BIONTECH)) | PFIZER\BIONTECH | 1 | — | IM |
Reported Symptoms: 10019203:HEART RATE IRREGULAR; Narrative: a 31yo male with PMH of Chronic Eczema of External Auditory Canal, Tonsillar enlargement, Chronic Back Pain and Overactive Bladder. The patient presented to the facility on October 2, 2025 for a scheduled appointment. Per the Physician, Subjective note the patient has a history of Myocarditis x 2 in 2023 but had normal stress test and was seen by cardiology at that time. MRI 2023 - showed mild biventricular dilation and low normal LVEF ( 65% RF per ECHO), no valvular disease and LVH. Currently no C/P, SOB, Palpitations or Syncope. However the physician reported the patient had a historical ADR of Pfizer Covid - 19 vaccine induced Irregular Heart Rate. Per the patient's vaccine history, he received last Pfizer Mrna, Lnp-S 30mcg/0.3ml dose on May 5, 2022 No other detailed information was provided regarding the vaccine, NDC#, Exp. date, site of administration, who administered the vaccine, the physician in charge at the time, severity of reaction and/ or if any measure was taken etc Other Relevant HX: Other: IRREGULAR HEART RATE