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