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VAERS Report 2136880

Case Report Section

Détails du rapport Vaer

Âge: N/A

Genre: Male

Région : Outside US

Patient décédé?
Non
Renseignements sur les vaccins

Nom: COVID19 (COVID19 (PFIZER-BIONTECH))

Type : Coronavirus 2019 vaccine

Fabricant: PFIZER

Lot: fd6840


Date de réception du rapport
2022-02-24
Date à laquelle le formulaire est complèté
Date de vaccination
2021-06-30
Date d’apparition
124
Nombre de jours (date d’apparition – date de vaccination)
124
Description de l’événement indésirable

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-2022-015015. a 45 year-old male patient received bnt162b2 (comirnaty), intramuscular, administration date 30jun2021 (lot number: fd6840) as dose 2, single and intramuscular, administration date 19may2021 (lot number: fa4598) 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 01nov2021, outcome "unknown", described as "vaccination failure"; covid-19 (medically significant) with onset 01nov2021, outcome "unknown", described as "sars-cov-2 infection". the patient underwent the following laboratory tests and procedures: sars-cov-2 test: (01nov2021) positive. no follow-up attempts are possible. no further information is expected.; sender's comments: linked report(s) : at-pfizer inc-202200295121 same patient/product/reporter, different dose /event

Données de laboratoire
test date: 20211101; test name: covid-19 pcr test; test result: positive
Liste des symptômes
drug ineffective covid-19 sars-cov-2 test
Patient décédé?
Non
Date de décès
N/A
Anomalie congénitale
false
Vaccin administré par :
Other
Vaccin acheté par :
Inconnu
Visite d’un patient à l’urgence?
Non
Patient hospitalisé?
Non
Séjour à l’hôpital
Non
Nombre de jours à l’hôpital
Non spécifié
Invalidité permanente?
Non
Allergies:
na
Maladie actuelle
na