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VAERS Report 2136960

Case Report Section

Détails du rapport Vaer

Âge: N/A

Genre: Female

Région : Outside US

Patient décédé?
Non
Renseignements sur les vaccins

Nom: COVID19 (COVID19 (PFIZER-BIONTECH))

Type : Coronavirus 2019 vaccine

Fabricant: PFIZER

Lot: ey3014


Date de réception du rapport
2022-02-24
Date à laquelle le formulaire est complèté
Date de vaccination
2021-05-07
Date d’apparition
177
Nombre de jours (date d’apparition – date de vaccination)
177
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-2022-015146 (ra). a 77 year old female patient received bnt162b2 (comirnaty, formulation: solution for injection, lot number: ey3014), intramuscular, administration date 07may2021 as dose 2, single and intramuscular, administration date 16apr2021 (comirnaty, formulation: solution for injection, lot number: ew2239) as dose 1, single for covid-19 immunization. the patient's relevant medical history was not reported. there were no concomitant medications. the patient's weight was not reported, and height was not reported. the following information was reported: vaccination failure (medically significant) with onset 31oct2021, outcome "unknown", described as "vaccination failure"; covid-19 (medically significant) with onset 31oct2021, outcome "unknown", described as "sars-cov-2 infection". the patient underwent the following laboratory tests and procedures: sars-cov-2 test: (31oct2021) 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

Données de laboratoire
test date: 20211031; test name: covid-19 pcr test; test result: positive ; comments: variant pcr-based: b.1.617.2 variant sequenced: n.a. n501y-positive: no
Liste des symptômes
covid-19 sars-cov-2 test vaccination failure
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