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VAERS Report 2136818

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: fd4555


Date report was received
2022-02-24
Date form completed
Date Vaccinated
2021-06-25
Date of Onset
122
Number of days (onset date – vaccination date)
122
Adverse Event Description

vaccination failure; sars-cov-2 infection; this is a spontaneous report received from a contactable reporter(s) (physician) from the regulatory authority-web. regulatory number: at-basgages-2022-008800 (ra). a 17 year-old male patient received bnt162b2 (comirnaty), intramuscular, administration date 25jun2021 (lot number: fd4555) as dose 2, single and intramuscular, administration date 14may2021 (lot number: ey7015) 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 (medically significant) with onset 25oct2021, outcome "unknown", described as "vaccination failure"; covid-19 (medically significant) with onset 25oct2021, outcome "unknown", described as "sars-cov-2 infection". the patient underwent the following laboratory tests and procedures: sars-cov-2 test: (25oct2021) positive, notes: variant pcr-based: n/a; variant sequenced: n/a; n501y-positive: unknown. no follow-up attempts are possible. no further information is expected.; sender's comments: linked report(s) : at-pfizer inc-202200280770 same patient/ same suspect/ inappropriate of schedule of vaccine administered

Lab Data
test date: 20211025; test name: covid-19 pcr test; test result: positive ; comments: variant pcr-based: n/a; variant sequenced: n/a; n501y-positive: unknown
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