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VAERS ID: 2275419

AGE: 65| SEX: F|State: AZ

Description

COVID 19 Treatment; COVID 19 Treatment; This is a spontaneous report received from a contactable reporter(s) (Consumer or other non HCP). The reporter is the patient. A 65-year-old female patient (not pregnant) received BNT162b2 (BNT162B2), on 05Apr2022 as dose 4 (booster), single (Batch/Lot number: unknown) at the age of 65 years, in right arm for covid-19 immunisation; coviD-19 vaccine (COVID-19 VACCINE), as dose 1, single (Batch/Lot number: unknown), as dose 2, single (Batch/Lot number: unknown) and as dose 3 (booster), single (Batch/Lot number: unknown) for covid-19 immunisation. The patient's relevant medical history included: "Type 2 diabetes" (unspecified if ongoing); "Hypertension" (unspecified if ongoing). Concomitant medication(s) included: HCTZ; METOPROLOL [METOPROLOL TARTRATE]; LOSARTAN; ASPIRIN LOW; MELATONIN; CRANBERRY; VITAMIN B2 [RIBOFLAVIN]; MAGNESIUM GLYCINATE. Past drug history included: Compazine, reaction(s): "Known allergies: Compazine"; Lisinopril, reaction(s): "Known allergies: Lisinopril". The following information was reported: COVID-19 (medically significant), outcome "recovering", DRUG INEFFECTIVE (medically significant), outcome "unknown" and all described as "COVID 19 Treatment". Therapeutic measures were taken as a result of covid-19, drug ineffective. The lot number for the vaccine, [BNT162B2], was not provided and will be requested during follow up.

Symptoms

COVID-19, Drug ineffective

Vaccines

VAX DATE: 04 April 2022 | ONSET DATE: | DAYS TO ONSET:
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • PFIZERBIONTECH
  • UNKNOWN MANUFACTURER
  • COVID19 (COVID19 (PFIZER-BIONTECH))
  • COVID19 (COVID19 (UNKNOWN))
  • 3
  • 4
  • RA

RECVDATE:12 May 2022
CAGE_YR:
CAGE_MO:
RPT_DATE:
DIED:
DATEDIED:
L_THREAT:
ER_VISIT:
HOSPITAL:
HOSPDAYS:
X_STAY:
DISABLE:
RECOVD:N
LAB_DATA:
V_ADMINBY:UNK
OTHER_MEDS:HCTZ; METOPROLOL [METOPROLOL TARTRATE]; LOSARTAN; ASPIRIN LOW; MELATONIN; CRANBERRY; VITAMIN B2 [RIBOFLAVIN]; MAGNESIUM GLYCINATE
CUR_ILL:
HISTORY:Medical History/Concurrent Conditions: Hypertension; Type 2 diabetes mellitus
PRIOR_VAX:
SPLTTYPE:USPFIZER INC202200691051
FORM_VERS:2
TODAYS_DATE:11 May 2022
BIRTH_DEFECT:
OFC_VISIT:
ER_ED_VISIT:
ALLERGIES:
V_FUNDBY:
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