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VAERS Report 2157001

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
2021-11-01
Date of Onset
63
Number of days (onset date – vaccination date)
63
Adverse Event Description

sars-cov-2 infection; sars-cov-2 infection; this is a spontaneous report received from a contactable reporter(s) (consumer or other non hcp) from the ra. a female patient received bnt162b2 (comirnaty), administration date nov2021 (batch/lot number: unknown) as dose 3 (booster), single, administration date apr2021 (batch/lot number: unknown) as dose 2, single and administration date jan2021 (batch/lot number: unknown) as dose 1, single for covid-19 immunisation. the patient's relevant medical history and concomitant medications were not reported. it was reported that patient has not had symptoms associated with covid-19. the following information was reported: drug ineffective (medically significant) with onset 03jan2022, outcome "unknown", suspected covid-19 (medically significant) with onset 03jan2022, outcome "recovered" (05jan2022) and all described as "sars-cov-2 infection". the patient underwent the following laboratory tests and procedures: sars-cov-2 test: negative, notes: no - negative covid-19 test. patient was not enrolled in clinical trial. the report does not relate to possible inflammation of the heart (myocarditis or pericarditis). 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-202200298677 same patient/product/ reporter, different dose number/ event

Lab Data
test name: covid-19 virus test; test result: negative ; comments: no - negative covid-19 test
List of symptoms
drug ineffective sars-cov-2 test suspected covid-19
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