Page breadcrumb nav

VAERS Report 2157023

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: fk9707


Date report was received
2022-03-04
Date form completed
Date Vaccinated
2021-12-15
Date of Onset
73
Number of days (onset date – vaccination date)
73
Adverse Event Description

covid-19 positive test by lft; covid-19 positive test by lft; this is a spontaneous report received from contactable consumer from product quality and a sales representative. the reporter is the patient. a male patient received bnt162b2 (comirnaty, solution for injection), intramuscular, administered in arm left, administration date 15dec2021 12:00 (lot number: fk9707) as dose 3 (booster), single; intramuscular, administered in arm left, administration date 24may2021 12:00 (lot number: et1831) as dose 2, single; and intramuscular, administered in arm left, administration date 04may2021 12:00 (lot number: et3620) as dose 1, single for covid-19 immunisation. the patient's relevant medical history was not reported. there were no concomitant medications (no other vaccines within 4 weeks prior to the covid vaccine and other medications received within 2 weeks of vaccination). the following information was reported: vaccination failure (medically significant) with onset 26feb2022 08:00, outcome "unknown", covid-19 (medically significant) with onset 26feb2022 08:00, outcome "not recovered" and all described as "covid-19 positive test by lft". the patient underwent the following laboratory tests and procedures: sars-cov-2 test: (26feb2022) positive, notes: nasal swab. therapeutic measures were not taken as a result of covid-19. no follow-up attempts are possible. no further information is expected.; sender's comments: linked report(s) : gb-pfizer inc-2021611909 same patient/suspect drug, different dose number/event;gb-pfizer inc-202101819200 same patient/suspect drug, different dose number/event

Lab Data
test date: 20220226; test name: lft; test result: positive ; comments: nasal swab
List of symptoms
covid-19 sars-cov-2 test vaccination failure
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