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VAERS Report 2156961

Case Report Section

Vaer Report Details

Age: NA

Gender: Unknown

State: Outside US

Patient Died?
Vaccine information


Type: Coronavirus 2019 vaccine

Manufacturer: PFIZER

Lot: fe3380

Date report was received
Date form completed
Date Vaccinated
Date of Onset
Number of days (onset date – vaccination date)
Adverse Event Description

positive covid lateral flow test; positive covid lateral flow test; this is a spontaneous report received from contactable reporter(s) (consumer or other non hcp) from a sales representative. the reporter is the patient. a 22 year-old patient received bnt162b2 (comirnaty), intramuscular, administered in arm, administration date 23aug2021 10:40 (lot number: fe3380) as dose 2, single and intramuscular, administered in arm, administration date 28jun2021 10:30 (lot number: fc8289) as dose 1, single for covid-19 immunisation. the patient had no relevant medical history. there were no concomitant medications. the following information was reported: drug ineffective (medically significant), covid-19 (medically significant), outcome "unknown" and all described as "positive covid lateral flow test". the patient underwent the following laboratory tests and procedures: antibody test: unknown results, notes: antibody test to platelet factor iv; sars-cov-2 test: positive, notes: positive covid lateral flow test. clinical course: positive covid lateral flow test and covid symptoms (cold, headache, fatigue) in patient who has had pfizer covid vaccine. optional information: last pfizer covid vaccine was administered 6 months before positive test and patient has had booster jab from different company in the meantime. the patient took no prior vaccinations (within 4 weeks) and specific relevant test for thromboembolic events with thrombocytopenia was none. follow-up (21feb2022): this is a spontaneous follow-up report from a contactable consumer. this consumer reported in response to the non-hcp letter sent that included: updated information: reporter detail (slider#01) was updated. patient age was added. relevant medical history and concomitant medications details were updated. suspect product details (dose 1 and dose 2) were updated. lab tests were added, and narrative updated accordingly. no follow-up attempts are possible. no further information is expected

Lab Data
test name: antibody test; result unstructured data: test result:unknown results; comments: antibody test to platelet factor iv; test name: lateral flow test; test result: positive ; comments: positive covid lateral flow test
List of symptoms
drug ineffective covid-19 sars-cov-2 test antibody test
Patient Died?
Date Died
Birth defect
Vaccine Administered By:
Vaccine Purchased By:
Patient visit ER?
Patient Hospitalized?
Stay in hospital
Days in hospital
Permanent disability?
Current Illness