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VAERS Report 2157029

Case Report Section

Vaer Report Details

Age: NA

Gender: Female

State: Outside US

Patient Died?
No
Vaccine information

Name: COVID19 (COVID19 (PFIZER-BIONTECH))

Type: Coronavirus 2019 vaccine

Manufacturer: PFIZER

Lot: fa1027


Date report was received
2022-03-04
Date form completed
Date Vaccinated
2021-06-26
Date of Onset
127
Number of days (onset date – vaccination date)
127
Adverse Event Description

covid-19 confirmed by positive covid-19 test; covid-19 confirmed by positive covid-19 test; this is a spontaneous report received from a contactable reporter(s) (consumer or other non hcp) from the ra. aa 48 year-old female patient (not pregnant) received bnt162b2 (bnt162b2), administration date 26jun2021 (lot number: fa1027) as dose 2, single and administration date 25may2021 (lot number: et8885) as dose 1, single for covid-19 immunisation. the patient's relevant medical history and concomitant medications were not reported. patient was not currently breastfeeding. the patient's concomitant medications were not reported. patient last menstrual period date was 10feb2022. the following information was reported: vaccination failure (medically significant), covid-19 (medically significant) all with onset 31oct2021, outcome "recovered" (08nov2021) and all described as "covid-19 confirmed by positive covid-19 test". the patient underwent the following laboratory tests and procedures: sars-cov-2 test: (31oct2021) yes - positive covid-19 test. no follow-up attempts are possible. no further information is expected.; sender's comments: linked report(s) : gb-pfizer inc-202200298715 same patient/product, different dose/events; gb-pfizer inc-202200348146 same patient/product, different dose/events

Lab Data
test date: 20211031; test name: covid-19 virus test; result unstructured data: test result:yes - positive covid-19 test
List of symptoms
covid-19 sars-cov-2 test vaccination failure
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