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VAERS Report 2157015

Case Report Section

Vaer Report Details

Age: NA

Gender: Male

State: Outside US

Patient Died?
No
Vaccine information

Name: COVID19 (COVID19 (PFIZER-BIONTECH))

Type: Coronavirus 2019 vaccine

Manufacturer: PFIZER

Lot: fh4751


Date report was received
2022-03-04
Date form completed
Date Vaccinated
2021-11-12
Date of Onset
95
Number of days (onset date – vaccination date)
95
Adverse Event Description

sars-cov-2 infection; sars-cov-2 infection; this is a spontaneous report received from a contactable consumer from the regulatory authority. a 75 year-old male patient received bnt162b2 (comirnaty), administration date 12nov2021 (lot number: fh4751) as dose 3 (booster), single for covid-19 immunisation; covid-19 vaccine (covid-19 vaccine) (batch/lot number: unknown) as dose 2, single and (batch/lot number: unknown) as dose 1, single for covid-19 immunisation. relevant medical history included: "blood pressure high" (unspecified if ongoing). it was unsure if patient had had symptoms associated with covid-19 and the patient had not had a covid-19 test. patient was not enrolled in clinical trial. concomitant medications included: amlodipine, start date: 2018; indapamide, start date: 2019; influenza virus taken for immunisation, administration date 04oct2021; losartan taken for hypertension, start date: apr2012; oxybutynin, start date: 2012; paracetamol. the following information was reported: drug ineffective (medically significant), suspected covid-19 (medically significant) all with onset 15feb2022, outcome "recovering" and all described as "sars-cov-2 infection". no follow-up attempts are possible. no further information is expected.; sender's comments: linked report(s) : gb-pfizer inc-202200315544 same reporter/patient/vaccine, different events

Lab Data
na
List of symptoms
drug ineffective 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