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VAERS Report 2157027

Case Report Section

Vaer Report Details

Age: 45 years old

Gender: Female

State: Outside US

Patient Died?
No
Vaccine information

Name: COVID19 (COVID19 (PFIZER-BIONTECH))

Type: Coronavirus 2019 vaccine

Manufacturer: PFIZER

Lot: fk0596


Date report was received
2022-03-04
Date form completed
Date Vaccinated
2021-11-09
Date of Onset
52
Number of days (onset date – vaccination date)
52
Adverse Event Description

drug ineffective; covid-19; this is a spontaneous report received from a contactable consumer or other non hcp. the reporter is the patient. a 46 year-old female patient received bnt162b2 (comirnaty), administered in arm right, administration date 09nov2021 (lot number: fk0596) at the age of 45 years as dose 3 (booster), single, administration date 05may2021 (lot number: er7934) as dose 2, single and administration date 24feb2021 (lot number: er1741) as dose 1, single for covid-19 immunisation. the patient's relevant medical history was not reported. concomitant medication included: shingrix taken for immunisation, administration date 02nov2021. the following information was reported: drug ineffective (medically significant) with onset 31dec2021, outcome "unknown", described as "drug ineffective"; covid-19 (medically significant) with onset 31dec2021, outcome "unknown", described as "covid-19". the patient underwent the following laboratory tests and procedures: sars-cov-2 test: (31dec2021) positive, notes: nasal swab.; sender's comments: linked report(s) : gb-pfizer inc-202200232861 same patient/drug, different dose/event;gb-pfizer inc-202200217749 same patient/product, different dose/event

Lab Data
test date: 20211231; test name: covid lateral flow test; test result: positive ; comments: nasal swab
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