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VAERS Report 2156995

Case Report Section

Vaer Report Details

Age: NA

Gender: Female

State: Outside US

Patient Died?
No
Vaccine information

Name: COVID19 (COVID19 (PFIZER-BIONTECH))

Type: Coronavirus 2019 vaccine

Manufacturer: PFIZER

Lot: unknown


Date report was received
2022-03-04
Date form completed
Date Vaccinated
2021-10-28
Date of Onset
111
Number of days (onset date – vaccination date)
111
Adverse Event Description

sars-cov-2 infection; sars-cov-2 infection; this is a spontaneous report received from a contactable reporter (consumer or other non hcp) from the regulatory authority (ra). a 74 year-old female patient received bnt162b2 (comirnaty), administration date 28oct2021 (batch/lot number: unknown) as dose 3 (booster), single for covid-19 immunisation; covid-19 vaccine nrvv ad (chadox1 ncov-19) (covid-19 vaccine astrazeneca), administration date 22oct2021 (batch/lot number: unknown) as dose 2, single and administration date 18sep2021 (batch/lot number: unknown) as dose 1, single for covid-19 immunisation. relevant medical history included: "immunodeficiency" (unspecified if ongoing), notes: taking other treatments or medicines, not listed above, known to lower the immune response and i... the patient's concomitant medications were not reported. the following information was reported: drug ineffective (medically significant) with onset 16feb2022, outcome "unknown", covid-19 (medically significant) with onset 16feb2022, outcome "not recovered" and all described as "sars-cov-2 infection". the event "sars-cov-2 infection" was evaluated at the physician office visit. the patient underwent the following laboratory tests and procedures: sars-cov-2 test: (16feb2022) yes - positive covid-19 test. therapeutic measures were taken as a result of covid-19 which includes prescription medications. no follow-up attempts are possible; information about lot/batch number cannot be obtained. no further information is expected.; sender's comments: linked report(s) : gb-pfizer inc-202200298618 same reporter, patient and product; different dose and event

Lab Data
test date: 20220216; test name: covid-19 virus test; result unstructured data: test result:yes - positive covid-19 test
List of symptoms
drug ineffective covid-19 sars-cov-2 test
Patient Died?
No
Date Died
NA
Birth defect
false
Vaccine Administered By:
Other
Vaccine Purchased By:
Unknown
Patient visit ER?
No
Patient Hospitalized?
No
Stay in hospital
No
Days in hospital
Unspecified
Permanent disability?
No
Allergies:
na
Current Illness
na