Page breadcrumb nav

VAERS Report 2136904

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: ff0680


Date report was received
2022-02-24
Date form completed
Date Vaccinated
2021-07-30
Date of Onset
90
Number of days (onset date – vaccination date)
90
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-2022-015061. a 62 year-old male patient received bnt162b2 (comirnaty), intramuscular, administration date 30jul2021 (lot number: ff0680) as dose 2, single and intramuscular, administration date 15jun2021 (lot number: fd1921) 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 28oct2021, outcome "unknown", described as "vaccination failure"; covid-19 (medically significant) with onset 28oct2021, outcome "unknown", described as "sars-cov-2 infection". the patient underwent the following laboratory tests and procedures: sars-cov-2 test: (28oct2021) positive, notes: variant pcr-based: b.1.617.2, variant sequenced: n.a., n501y positive: no. no follow-up attempts are possible. no further information is expected.; sender's comments: linked report(s) : at-pfizer inc-202200295721 same patient and inappropriate schedule of vaccine administered

Lab Data
test date: 20211028; test name: covid-19 pcr test; test result: positive ; comments: variant pcr-based: b.1.617.2, variant sequenced: n.a., n501y positive: no
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