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VAERS Report 2157016

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: fm3092


Date report was received
2022-03-04
Date form completed
Date Vaccinated
2021-12-17
Date of Onset
15
Number of days (onset date – vaccination date)
15
Adverse Event Description

covid-19 antigen test- positive/ tested positive for covid on lateral flow; covid-19 antigen test- positive/ tested positive for covid on lateral flow; this is a spontaneous report received from a contactable reporter(s) (physician) from the regulatory authority (ra) and health authority. a 17-year-old female patient (not pregnant) received bnt162b2 (comirnaty), administration date 17dec2021 (lot number: fm3092) as dose 2, 0.3 ml single and administration date 14aug2021 (lot number: fe8087) as dose 1, single for covid-19 immunisation. the patient's relevant medical history and concomitant medications were not reported. the following information was reported: drug ineffective (hospitalization), covid-19 (hospitalization) all with onset jan2022, outcome "unknown" and all described as "covid-19 antigen test- positive/ tested positive for covid on lateral flow". the patient was hospitalized for drug ineffective, covid-19 (start date: 28jan2022). the event "covid-19 antigen test- positive/ tested positive for covid on lateral flow" was evaluated at the physician office visit. the patient underwent the following laboratory tests and procedures: lumbar puncture: (unspecified date) clear, notes: had lumbar puncture, which was clear; sars-cov-2 test: (jan2022) positive; (unspecified date) positive, notes: tested positive for covid on lateral flow done at home in early january as per patient / family. clinical course: patient is not pregnant. patient is not currently breastfeeding. the patient admitted to hospital with back pain, anal incontinence and difficulty walking on 28jan2022, had lumbar puncture, which was clear. at that time, fatigue and weight loss had been ongoing for a couple of months as per mum. no follow-up attempts are possible. no further information is expected

Lab Data
test name: lumbar puncture; result unstructured data: test result:clear; comments: had lumbar puncture, which was clear; test date: 202201; test name: covid-19 antigen test; test result: positive ; test name: lateral flow; test result: positive ; comments: tested positive for covid on lateral flow done at home in early january as per patient / family
List of symptoms
drug ineffective lumbar puncture 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?
Yes
Stay in hospital
No
Days in hospital
Unspecified
Permanent disability?
No
Allergies:
na
Current Illness
na